Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction

Abstract

Objective: The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap.

Methods: Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2-5 digits by HeNI flap (n = 16), rHoNI flap (n = 17), or CF flap (n = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work.

Results: The mean age of all patients was 36.9 years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72 months. The most common cause was work-related (n = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps.

Conclusion: The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.

Keywords: Cross-finger; Fingertip; Heterodigital; Homodigital; Neurovascular.

Fig. 1

From preoperative to late postoperative consequative views of a heterodigital artery island flap to a left index finger of a 26-years-old male patient due to machinery-tool in workplace respectively. a-c Preoperative views and planning, d-i Views just after the dissection and localization of the flap, j-l Suturation of the flap form donor side to recipient debridated side, m-n Primary closure of the donor side, o Late postoperative view of the patient

Fig. 2

From preoperative to late postoperative consequative views of a reverse homodigital artery islan flap to a right index finger of a 36-years-old male patient due to carpentary-tool in workplace respectively. a Preoperative view and planning, b Intraoperative view of the digit after the elevation of the cutaneous flaps between the defect and the flap’s donor site, and the flap was inserted into the tip defect and the donor site was covered with a full thickness skin graft harvested from the inner arm region, c Early and late postoperative views of the reconstructed digit

Fig. 3

From preoperative to late postoperative consequative views of a cross-finger flap to a left index finger of a 40-years-old male patient due to furniture industry-tool in workplace respectively. a Preoperative views before radical debridement, b The intraoperative views of the elevated flap over the paratenon was inserted into the pulp defect and the donor site was covered with a full thickness skin graft harvested from the inner arm region. At the lower images, early postoperative views after division of the flap were shown, c-h Late postoperative views of the reconstructed digit