Use of homodigital reverse island flaps for distal digital reconstruction

Abstract

Background: The homodigital reverse vascular island flap-a regional, axial-patterned skin flap elevated with a vascular pedicle from the proximal digit-is a one-step procedure used to replace skin and soft tissue loss or destruction in the distal finger. The purpose of this study was to evaluate the clinical outcome.

Methods: From April 1993 to June 2005, 58 patients with a soft-tissue defect at the distal part of the finger were treated by homodigital island flaps for reconstruction. A "sensory" form island flap was used for defects in the pulps or fingertip, using reanastomosis of the terminal nerve end to the sensory nerve in the flap. We evaluated the active range of motion of the involved finger, hypersensitivity and cold intolerance, the patient's satisfaction with the appearance of the finger and the operation, and a two-point discrimination and pulp writing test, with at least 1 year of follow-up.

Results: Forty-five patients were followed up for at least 1 year after operation; 24 patients were treated with sensory-form reverse island flaps. The patients rarely complained of pain, anesthesia, or the cold intolerance of the flap. Both dynamic and static two-point discriminations were better in the sensory form than in the "arterial" form reverse vascular flap, with statistical difference. Seven patients aged older than 50 years were successfully treated and had a good functional outcome.

Conclusions: The homodigital reverse island flap is an ideal surgical treatment for distal digital defects with a lower complication rate and good functional result, and the indication of age can be extended for older patients with a good preoperative evaluation.