Volar Neurovascular Advancement Flap With an All Neural Branch-preserving Technique

Several fingertip reconstruction options exist, among which, the use of a volar advancement flap or local transposition flap is a simple and effective technique for reconstructing the volar pulp with the same skin texture. To advance the flap, we have to release the tethering structure and sometimes include the neural branches. We describe a concept of an all neural branch-preserving technique to harvest a volar flap. We demonstrate this technique on an anatomic specimen and 1 case with delicate surgical tips. We performed this technique in 16 patients, and the mean follow-up period was 28.4 months. The mean range of motion of the distal interphalangeal joint was 70.3 degrees, and that of the proximal interphalangeal joint was 101.9 degrees. The mean static 2-point discrimination of the volar pulp was 4.8 mm. This technique could be applied on the volar advancement flap with a better sensation recovery.