The neurovascular island pedicle flap

Area of Science:

• Reconstructive surgery
• Hand surgery
• Microsurgery

Background:

• Irreparable nerve damage to the thumb significantly impairs hand function.
• Restoring sensation and motor control is crucial for thumb utility.

Purpose of the Study:

• To assess the long-term outcomes of neurovascular island pedicle flap reconstruction for thumb nerve defects.
• To evaluate sensory recovery, functional results, and potential complications.

Main Methods:

• Nine patients with irreparable thumb nerve damage underwent flap reconstruction using tissue from the third or fourth finger.
• Patients were re-examined 9 months to 8 years post-surgery.
• Outcomes assessed included two-point discrimination, Ninhydrin test, cortical reorientation, and overall thumb function.

Main Results:

• Eight patients achieved two-point discrimination <15 mm in the flap area, with all showing positive Ninhydrin tests.
• Two patients had complete cortical reorientation, and three had partial reorientation.
• Six patients reported good or fair thumb function; however, three experienced poor results and required reoperation due to contractures.

Conclusions:

• Neurovascular island pedicle flap reconstruction is a viable option for thumb nerve defects, particularly in young, motivated individuals.
• Careful patient selection is important to optimize functional outcomes and minimize complications like contractures.