Functional Outcomes of Antegrade Homodigital Neurovascular Island Flaps for Fingertip Amputation.

BACKGROUND: Fingertip amputations can be debilitating and challenging to treat, due to the need for both function and cosmesis. We studied the functional outcomes of patients receiving an antegrade homodigital neurovascular island flap for fingertip amputations.

METHODS: From 2004 to 2013, we performed 13 cases of antegrade homodigital neurovascular island flaps. Functional outcomes were studied. Four had Allen Zone II and nine had Zone III injuries. Seven were performed as secondary surgery. The mean followup period was 36 weeks.

RESULTS: All the flaps survived. Ten of 11 had less than or equal to 6 mm two-point discrimination. Five patients were noted to have mild flexion contracture at distal interphalangeal joints ranging from 5 to 10 degrees. There were three cases with nail deformity, three with fingertip hypersensitivity and four with cold intolerance. For patients injured on duty, the mean duration of sick leave taken was 18.5 weeks.

CONCLUSIONS: With careful patient selection, the antegrade homodigital neurovascular island flap is a reliable means of restoring the function of the fingertip after amputation injury with significant tissue loss. Flap survival, sensibility and mobile adjacent joint can be expected, even when performed as a secondary surgery and for patients with work-related injuries.