Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects

Abstract

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher's first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes-Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes-Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects.

Level of evidence: Therapeutic, level III.

Keywords: Thumb pulp defect; dorsal branch; first dorsal metacarpal artery; island flap; proper digital nerve; thumb degloving injury.