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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Hand Surgery

Background:

  • Volar soft-tissue defects in digits require reconstruction to restore function and sensation.
  • Innervated toe pulp (TP) and noninnervated medialis pedis (MP) flaps are surgical options for these defects.
  • Comparing objective and subjective outcomes of TP and MP flaps is crucial for optimizing reconstructive strategies.

Purpose of the Study:

  • To compare the functional and sensory outcomes of innervated toe pulp (TP) flaps versus noninnervated medialis pedis (MP) flaps for digital soft-tissue defect reconstruction.
  • To evaluate patient-reported outcomes and subjective complaints associated with each flap type.
  • To provide evidence-based guidance for selecting the most appropriate flap for volar digital reconstructions.

Main Methods:

  • A retrospective study of 101 free glabrous skin flap reconstructions (75 TP, 26 MP) for volar digital soft-tissue injuries between 1998 and 2017.
  • Utilized validated questionnaires: Michigan Hand Outcomes Questionnaire, Disabilities of the Arm, Shoulder and Hand Questionnaire, and Foot and Ankle Disability Index.
  • Conducted sensory testing including two-point discrimination and Semmes-Weinstein monofilament testing, with data analyzed using Mann-Whitney U test and Pearson correlation.

Main Results:

  • No significant differences in functional or sensory outcomes were observed between TP and MP flaps in 29 participants (average follow-up: 106 months).
  • Both flap types demonstrated satisfactory function and sensibility, with comparable patient-reported outcomes.
  • Minor subjective complaints, such as cold intolerance and donor site discomfort, were noted in the TP flap group.

Conclusions:

  • Innervated toe pulp (TP) and noninnervated medialis pedis (MP) flaps are viable options for volar digital defect reconstruction, offering comparable coverage and sensory results.
  • The selection of TP versus MP flaps should be individualized based on patient needs and specific defect characteristics.
  • Further investigation into the long-term efficacy of these flap types, particularly for extensive defects, is warranted.