Factors affecting sensory recovery after thumb reconstruction using a wrap-around flap

Reverse homodigital dorsoradial flaps for thumb coverage obtained good sensory recovery after a long time follow up

Reverse homodigital dorsoradial flap (RHDF) of the thumb has become a qualified option for the reconstruction of thumb tissue defects. However, the sensory recovery of the flap in long term is still unknown. Therefore, this study focused on the sensory recovery of RHDFs for the coverage of thumb in hand after a long-term follow-up. From January 2010 to March 2011, 18 patients (14 men and four women) were treated consecutively with an RHDF. All the patients were followed up two times. The pain and cold intolerance of the flap were self-reported by the patients. The sensory recovery of the flap was evaluated using Semmes-Weinstein (SW) monofilament, moving two-point discrimination (M-2PD) and static two-point discrimination (S-2PD) tests. The average times of the first and second follow-up were 39 ± 4 and 88 ± 6 months, respectively. The mean value of SW monofilament sensitivity score and M-2PD at first follow-up was significantly higher than that of the second follow-up and contralateral thumb. The mean value of S-2PD at the second follow-up was significantly lower than that of the first follow-up and higher than that of the contralateral thumb. The cold intolerance severity score (CISS) at the first follow-up was higher than that at the second follow-up. No significant difference was found in terms of the pain between the two follow-ups. RHDFs without nerve coaptation for thumb coverage could obtain good sensory recovery after a long-term follow-up. Abbreviations: RHDF: reverse homodigital dorsoradial flap; CISS: cold intolerance severity score; SW: Semmes-Weinstein monofilament sensitivity score; M-2PD: moving two-point discrimination; S-2PD: static two-point discrimination; VAS: visual analog scale.

Evaluation of sensation in volume reduction techniques of a wrap-around flap

PURPOSE

Because the subcutaneous tissue of the great toe is thicker than that of the finger, the reconstructed finger tends to have bulging pulp when reconstructing with wrap-around flap (WAF) surgery. Secondary pulp plasty and thinning of the WAF are used to solve this cosmetic problem. This study aimed to examine the effect of these surgical techniques on sensation.

METHODS

A single-center retrospective study was conducted on posttraumatic patients who underwent digit reconstruction by WAF procedure by the same surgeon from February 2014 to June 2019. WAF cases were divided into three groups: a conventional WAF Group (A), a secondary pulp plasty (B), and a thin WAF Group (C). The Semmes-Weinstein monofilament test (SWMT) and two-point discrimination were used for examination.

RESULTS

All flaps survived; no cases developed partial flap necrosis. The sensation at the last follow-up in each group was good, achieving 4.31 (diminished protective sensation) or better in SWMT. The median SWMTs at the last follow-up were 4.08, 3.61, and 3.42 in Groups A, B, and C, respectively. Groups A and C showed a significant difference (p = .01). No significant differences were observed between groups A and B (p = .20) or between Groups B and C (p = .40). Static two-point discriminations (s2PDs) at the last follow-up were 14 ± 2.9 mm, 13 ± 3.7 mm, and 14 ± 1.5 mm in Groups A, B, and C, respectively. Moving two-point discriminations (m2PDs) at the last follow-up were 13 ± 4.5 mm, 12 ± 3.6 mm, and 14 ± 1.7 mm in Groups A, B, and C, respectively. Both s2PD and m2PD did not differ significantly (p = .37 and .47, respectively).

CONCLUSIONS

Secondary pulp plasty and thinning of WAF for finger reconstruction did not impact sensation.