Sensory Reconstruction of the Volar Aspect of the Finger, The Heterodigital Neurocutaneous Island Flap
Conditions
Keywords
Dorsal branch of the digital nerve;, dorsal digital artery;, dorsal digital island flap;, neurocutaneous island flap.
Brief summary
The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal digital island flap can be used for repairing the defect of adjacent finger, but the limited length of the pedicle precludes its use for a more distal defect. The heterodigital neurocutaneous island flap of the dorsal branch of the digital nerve can be used as an alternative to resolve this problem.
Detailed description
At final follow-up, we measured the sensibility of the flaps using the Semmes-Weinstein monofilament test and the static 2-point discrimination test. The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stopped at 4mm as a limit of 2PD and considered this normal.
Interventions
DEVICEthe neurocutaneous island flap
The neurocutaneous island flap of the dorsal branch of the digital nerve can be used for repair the defects of the proximal and middle phalanxes of adjacent fingers.
Sponsors
Chinese PLA General Hospital
The Second Hospital of Tangshan
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* the soft tissue defects involving the middle phalanx, the proximal interphalangeal joint, or both; * a defect greater than or equal to 2 cm in length; * a patient between 15 and 60 years of age.
Exclusion criteria
* concomitant injuries to the dorsal skin of the middle phalanx of adjacent finger that precluded its use as donor site; * injuries to the course of donor nerve branch; * a defect less than 1.5 cm in length; * a fingertip or pulp defect; * a soft tissue defect of the thumb.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Discriminatory Sensation of the Flap | 18 months to 24 months | Discriminatory sensation of the flap is evaluated with the Static 2-point Discrimination Test. The test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent \<6 mm; good 6-10 mm; fair 11-15 mm; poor \>15 mm. The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stop at 4mm as a limit of 2PD and considered this normal. These assessments take place at a single time point at the final follow-up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cold Intolerance | 18 months to 24 months | We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100). |
Countries
China
Participant flow
Recruitment details
From February of 2008 to March of 2011,12 patients with soft tissue defects in the middle phalanx or the proximal interphalangeal joint were included in the study.The type of location is medical clinic. These patients were treated with the neurocutaneous island flap.
Pre-assignment details
No wash out, run-in or transition happened in our study.
Participants by arm
| Arm | Count |
|---|---|
| Surgical Flap The neurocutaneous island flap is based on the dorsal branch of the digital nerve | 12 |
| Total | 12 |
Baseline characteristics
| Characteristic | Surgical Flap |
|---|---|
| Age, Categorical <=18 years | 1 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 11 Participants |
| Age, Continuous | 34.5 years STANDARD_DEVIATION 9.4 |
| Region of Enrollment China | 12 participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 9 Participants |
| Tissue reconstruction with the neurocutaneous island flap | 12 participants 1.2 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 12 |
| serious Total, serious adverse events | 0 / 12 |
Outcome results
Primary
Discriminatory Sensation of the Flap
Discriminatory sensation of the flap is evaluated with the Static 2-point Discrimination Test. The test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent \<6 mm; good 6-10 mm; fair 11-15 mm; poor \>15 mm. The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stop at 4mm as a limit of 2PD and considered this normal. These assessments take place at a single time point at the final follow-up.
Time frame: 18 months to 24 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Surgical Flap | Discriminatory Sensation of the Flap | 8.3 mm | Standard Deviation 1.6 |
Secondary
Cold Intolerance
We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100).
Time frame: 18 months to 24 months