A comparison of the dorsal digital island flap with the dorsal branch of the digital nerve versus the dorsal digital nerve for fingertip and finger pulp reconstruction.

BACKGROUND: Traumatic fingertip and finger pulp defects can be treated with dorsal digital island flaps. Either the dorsal branch of the digital nerve or the dorsal digital nerve can be included in the flap for sensory reconstruction. However, it is still unclear whether there are differences in the results between the two donor nerves.

METHODS: A retrospective study was conducted in 71 patients who had a fingertip or finger pulp defect treated with an innervated dorsal digital island flap from February of 2005 to June of 2011. The patients were divided into two groups based on which donor nerve was chosen. The donor nerve was coaptated to the digital nerve in the defect. At the final follow-up, the two groups were compared for static two-point discrimination, Semmes-Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction.

RESULTS: Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p < 0.05). The dorsal branch group presented slightly better discriminatory sensation in the flap and lower incidence of pain and cold intolerance in the injured finger. In addition, the dorsal branch group had a larger degree of satisfaction than the dorsal digital nerve group. No significant differences were found regarding Semmes-Weinstein monofilament flap score and total active motion of the finger.

CONCLUSION: When utilizing dorsal digital island flaps to reconstruct traumatic fingertip and finger pulp defects, choosing the dorsal branch rather than the dorsal digital nerve as the donor may attain better outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.