Treatment of a Combination of Volar Soft Tissue and Proper Digital Nerve Defects Using the Dorsal Digital Nerve Island Flap

Purpose A combination of volar soft tissue and proper digital nerve (PDN) defects in the middle and proximal phalanges can cause sensory loss of the finger pulp, which results in functional disability. This study reports treatment of these complex soft tissue defects using the dorsal digital nerve island flap (DDNIF) from the adjacent finger. Methods From May 2005 to October 2008, we used the DDNIF in 12 digits in 12 patients who had a combination of volar soft tissue and PDN defects in the middle phalanx, the distal third of the proximal phalanx, or both. The flaps ranged in size from 2.0 x 1.7 to 3.3 x 2.4 cm (mean, 2.8 x 1.9 cm). We reconstructed the PDN defect using the dorsal branch of the PDN graft harvested from the adjacent finger. The average length of the nerve grafts was 2.7 cm (range, 2.0-3.6 cm). Patient follow-up was 10 to 22 months, with a mean of 15 months. We evaluated sensibility of the pulp of the injured finger by moving and static 2-point discrimination. We measured the range of motion of the donor finger and compared the data with those of the opposite side. Hand appearance was assessed using the Michigan Hand Outcomes Questionnaire. We measured cold intolerance of the injured finger using the self-administered Cold Intolerance Severity Score questionnaire. Results All flaps survived completely. At the final follow-up, the mean values of moving and static 2-point discrimination were 5.4 and 7.2 mm in the pulps of the respective injured fingers. The range of motion of the donor finger was similar to that of the opposite side. The mean appearance score of the hands based on the Michigan Hand Outcomes Questionnaire was 18.5 (range, 17-20). All patients experienced mild finger cold intolerance. Conclusions The DDNIF can be used to cover the combination of volar soft tissue and PDN defects, restoring sensation in the pulp of the adjacent finger. (J Hand Surg 2010;35A.1665-1662. Copyright (C) 2010 by the American Society for Surgery of the Hand. All rights reserved.)