The Dorsal Homodigital Island Flap Based on the Dorsal Branch of the Digital Artery

Abstract

BACKGROUND: Soft-tissue reconstruction in the finger continues to evolve. This study reports reconstruction of small to moderate finger defects with the dorsal homodigital island flap and compares the results between the innervated and noninnervated flaps. METHODS: A retrospective study was conducted of 166 patients who had soft-tissue defects of the finger treated with the dorsal homodigital island flap (187 defects in 187 fingers in 166 patients). Mean defect size and flap size were 2.2 × 1.9 cm and 2.4 × 2.1 cm, respectively. When return of sensation was important, the dorsal branch of the digital nerve or the dorsal digital nerve was attached with the flap to restore neurosensory function. The main outcomes were static two-point discrimination and Semmes-Weinstein monofilament scores of the flap, fingertip pain, and joint motion. RESULTS: A significant difference was found between the innervated and noninnervated flaps in two-point discrimination, Semmes-Weinstein monofilament, and fingertip pain. The dual-innervated flap presented better discriminatory sensation on the flap and a lower incidence of fingertip pain than the noninnervated and single-innervated flap. In addition, the innervated flap obtained better Semmes-Weinstein monofilament scores than the noninnervated flap. For flaps harvested from the middle phalanx, the mean active motion arc of the distal interphalangeal joint was 69 degrees (range, 35 to 90 degrees). The contralateral side measured 73 degrees (range, 45 to 90 degrees) (significant difference, p = 0.041). Maximum amplitude losses of 15 degrees were seen in 10 percent of patients in the distal interphalangeal joint. CONCLUSION: The dorsal homodigital island flap is an alternative for tissue reconstruction in the finger. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.