Results of Thumb-pulp Loss Reconstruction with a Heterodigital Neurovascular Island Flap Using a Nerve Disconnecting-Reconnecting Technique

Journal of the Korean Society for Surgery of the Hand 2001;10(2):169-174.
Published online November 30, 2001.

Duke Whan Chung, M.D. and Gi Bong Kim, M.D.

무지 피부 결손에 신경 분리-문합을 이용한 이종 수지 신경혈관 도서형 유경 피판술의 결과

정덕환·김기봉

Abstract

Purpose : The problems of late deterioration of sensation and a double sensibility phenomenon are a known deficiency of the original neurovascular island flap. To eliminate this problems, the authors was performed to assess the results of Thumb-pulp loss reconstruction with a heterodigital neurovascular island Flap Using a Nerve Disconnecting-Reconnecting Technique
Material and Methods : Between July.1987 and November. 2000, we have used a disconnecting- reconnecting technique for heterodigital island flaps in which divided nerve of the transferred island flap is sutured to original nerve of the thumb in 9 patients. 9 patients with a mean follow-up period of 3.6 years were examined, while 7 patients were follow-up for 2years or more. Evaluation of results was based on flap quality, donor site quality, classic two-point sensory discrimination( 2PD), and location of sensation(double sensibility), donor site cold intolerance, neuroma formation, scar contractures, total active movement(TAM) of the thumb and donor digit and subjective results and objective results.
Results : The two-point discrimination was average 6.7 mm. Donor site paresthesia was observed more frequently in a short postoperative period. Sensation was referred to the thumb in all cases and the recovery occurred over a period of a two months. There were no flap complication or failures and the length of the thumb tip was preserved in all cases.
Conclusion : This technique was found to provide well-vascularized pulp of the thumb with proper cortical representation in one operative stage.

Key Words: Thumb-pulp loss, Neurovascular island Flap, Nerve disconnecting-reconnecting technique