Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap

BackgroundComplex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting.MethodsFrom March 2008 to September 2011, the nerve pedicle flap was used in 12 patients who had a combination of soft-tissue and digital nerve defects. The injured fingers included four index, four long, three ring and one little finger. The mean size of the soft-tissue losses was 2.4 × 1.9 cm (range, 2.3 × 1.3 to 3.2 × 2.0 cm). The mean flap size was 2.6 × 2.1 cm (range, 2.5 × 1.5 to 3.4 × 2.2 cm). The length of the nerve defects ranged from 1.5 to 3.8 cm (mean, 2.8 cm). The nerve defect was reconstructed with transfer of the digital nerve dorsal branch. For comparison, we collected a series of 24 patients with similar defects treated with the cross-finger flap and secondary free nerve grafting.ResultsSignificant differences were found between the two groups in static two-point discrimination (p < .01) and pain (p = .03) in the reconstructed finger. In comparison, the study group presented better discriminatory sensation on the finger pulp and lower incidence of pain sensibility in the injured finger. There was no significant difference in cold intolerance and Semmes–Weinstein monofilament. In the study group, the total active motion of the donor fingers was similar to that of the opposite hands.ConclusionsThe heterodigital arterialised nerve pedicle flap is useful and reliable for reconstructing the neurocutaneous defects in the proximal phalanx. Comparable sensory recovery and lower pain incidence can be achieved using our nerve pedicle flap instead of conventional nerve grafting.Type of study/level of evidenceTherapeutic II.