Glabrous Flow-Through Flaps for Simultaneous Resurfacing, Revascularization, and Reinnervation of Digits

Composite injuries of the volar surfaces of fingers are frequently associated with digital vessel and nerve damage. Flow-through glabrous flaps can provide esthetic tissue coverage as well as revascularization, and using a neurovascular flap, allows primary reconstruction of the digital nerve.

Between June 2010 and August 2014, we prospectively studied the use of Microsurgical flow-through glabrous flaps to achieve simultaneously digital revascularization and soft tissue coverage in 13 fingers of 12 patients who experienced volar injuries, comprising 6 great toe fibular flaps, 3 medial plantar flaps, 1 pedis medialis flap, and 3 hypothenar flaps. The nerve passing through the great toe fibular flap or medial plantar flap was used to repair digital nerve defects.

All flaps survived completely. During a mean follow-up period of 13.6 months, the majority recovered excellent appearance and function. The flaps had the characteristics of normal finger volar skin: hairless, with similar texture and color. The mean static 2-point discrimination and Semmes-Weinstein monofilament scores of finger pulp were 4.8 and 3.03 mmin the great toe fibular flap group, 7.3 and 3.89 mm in the medial plantar flap group, and 7.5 and 3.84 mm in the sural nerve group.

Glabrous flow-through flaps provide excellent reconstruction for fingers with volar injuries associated with digital vessel damage. The great toe fibular flap and the medial plantar flap are reliable and useful options for complicated finger injuries associated with digital vessel and nerve injuries.