Repair of Soft Tissue Defect of the Finger Using the Heterodigital Neurocutaneous Island Flap

Repair of Soft Tissue Defect of the Finger Using the Heterodigital Neurocutaneous Island Flap

The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal digital island flap can be used for repairing the defect of adjacent finger, but the limited length of the pedicle precludes its use for a more distal defect. The heterodigital neurocutaneous island flap of the dorsal branch of the digital nerve can be used as an alternative to resolve this problem.

At final follow-up, we measured the sensibility of the flaps using the Semmes-Weinstein monofilament test and the static 2-point discrimination test. The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stopped at 4mm as a limit of 2PD and considered this normal.

Inclusion Criteria:

• the soft tissue defects involving the middle phalanx, the proximal interphalangeal joint, or both;
• a defect greater than or equal to 2 cm in length;
• a patient between 15 and 60 years of age.

Exclusion Criteria:

• concomitant injuries to the dorsal skin of the middle phalanx of adjacent finger that precluded its use as donor site;
• injuries to the course of donor nerve branch;
• a defect less than 1.5 cm in length;
• a fingertip or pulp defect;
• a soft tissue defect of the thumb.