Evaluation of sensation in volume reduction techniques of a wrap-around flap

Because the subcutaneous tissue of the great toe is thicker than that of the finger, the reconstructed finger tends to have bulging pulp when reconstructing with wrap-around flap (WAF) surgery. Secondary pulp plasty and thinning of the WAF are used to solve this cosmetic problem. This study aimed to examine the effect of these surgical techniques on sensation.

A single-center retrospective study was conducted on posttraumatic patients who underwent digit reconstruction by WAF procedure by the same surgeon from February 2014 to June 2019. WAF cases were divided into three groups: a conventional WAF Group (A), a secondary pulp plasty (B), and a thin WAF Group (C). The Semmes-Weinstein monofilament test (SWMT) and two-point discrimination were used for examination.

All flaps survived; no cases developed partial flap necrosis. The sensation at the last follow-up in each group was good, achieving 4.31 (diminished protective sensation) or better in SWMT. The median SWMTs at the last follow-up were 4.08, 3.61, and 3.42 in Groups A, B, and C, respectively. Groups A and C showed a significant difference (p = .01). No significant differences were observed between groups A and B (p = .20) or between Groups B and C (p = .40). Static two-point discriminations (s2PDs) at the last follow-up were 14 ± 2.9 mm, 13 ± 3.7 mm, and 14 ± 1.5 mm in Groups A, B, and C, respectively. Moving two-point discriminations (m2PDs) at the last follow-up were 13 ± 4.5 mm, 12 ± 3.6 mm, and 14 ± 1.7 mm in Groups A, B, and C, respectively. Both s2PD and m2PD did not differ significantly (p = .37 and .47, respectively).

Secondary pulp plasty and thinning of WAF for finger reconstruction did not impact sensation.