Innervated Cross-Finger Pulp Flap for Reconstruction of the Fingertip

Background Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques.

Methods This study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods.

Results Most of the cases had cosmetically and functionally acceptable outcomes. The average defect size was 1.7×1.5 cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps.

Conclusions The innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.

Keywords

Finger injuries - Subcutaneous tissue - Microsurgery - Nerve transfer

This paper was supported by research funds from Research Institute of Clinical Medicine of Chonbuk National University in 2008.

Publikationsverlauf

Eingereicht: 26. August 2012

Angenommen: 27. September 2012

Artikel online veröffentlicht:
01. Mai 2022

• REFERENCES

• 1 Johnson RK, Iverson RE. Cross-finger pedicle flaps in the hand. J Bone Joint Surg Am 1971; 53: 913-919
• 2 Kappel DA, Burech JG. The cross-finger flap. An established reconstructive procedure. Hand Clin 1985; 1: 677-683
• 3 Miura T. Thumb reconstruction using radial-innervated cross-finger pedicle graft. J Bone Joint Surg Am 1973; 55: 563-569
• 4 Spokevicius S, Gupta A. The modified cross finger flap for finger pulp and nail bed reconstruction. J Hand Surg Br 1997; 22: 745-749
• 5 Cronin TD. The cross finger flap: a new method of repair. Am Surg 1951; 17: 419-425
• 6 Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946) 1950; 5: 368-371
• 7 Fisher RH. The Kutler method of repair of finger-tip amputations. J Bone Joint Surg Am 1967; 49: 317-321
• 8 Joshi BB. A sensory cross-finger flap for use on the index finger. Plast Reconstr Surg 1976; 58: 210-213
• 9 El-Khatib H. Adipofascial axial pattern cross-finger flap. Plast Reconstr Surg 1996; 97: 850-853
• 10 Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg 1983; 72: 688-697
• 11 Markley Jr JM. The preservation of close two-point discrimination in the interdigital transfer of neurovascular island flaps. Plast Reconstr Surg 1977; 59: 812-816
• 12 Ozdemir R, Kilinc H, Sensoz O. et al. Innervated dorsal adipofascial turnover flap for fingertip amputations. Ann Plast Surg 2001; 46: 9-14
• 13 Lassner F, Becker M, Berger A. et al. Sensory reconstruction of the fingertip using the bilaterally innervated sensory cross-finger flap. Plast Reconstr Surg 2002; 109: 988-993
• 14 Li YF, Cui SS. Innervated reverse island flap based on the end dorsal branch of the digital artery: surgical technique. J Hand Surg Am 2005; 30: 1305-1309