The results of reverse-flow island flaps in pulp reconstruction

Objective: The aim of this study was to retrospectively review the results of homodigital reverse-flow proximal or middle phalanx dorsal skin island flaps. Methods: We reviewed the overall results of 67 dorsal skin flap reconstructions performed on 61 proximal phalanxes and 6 middle phalanxes at our hospital during an 11-year period. The results were evaluated with static two-point discrimination, Semmes-Weinstein monofilament test, occurrence of nail deformities, loss of interphalangeal joint motion, scar appearance of flap donor area, the incidence of vascular insufficiency in postoperative period, and subjective evaluation of patient satisfaction. Results: The highest incidence of defect types were palmar oblique pulp defects in 18 patients (26.8%), transverse pulp defects in 16 patients (23.8%), and hemipulp oblique amputations in 11 patients (16.4%). Crush injuries were the cause of injury in 66% of patients. The average follow-up time was 40 months and long-term results were available in 21 patients. Total necrosis of flap in one patient (1.4%), superficial epidermolysis in 4 patients (5.9%), and nail deformity in 4 patients (5.9%) were seen. According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 76% of patients. Static two-point discrimination data showed variable distribution between 2 mm and. 11 mm. The subjective patient satisfaction level was 95%. Conclusion: Homodigital reverse-flow proximal or middle phalanx dorsal skin island-flaps give satisfactory cosmetic and sensorial results outside the pinch area, even if the dorsal branch of the digital nerve is not included.