Local arterialized island flap coverage of difficult hand defects preserving donor digit sensibility

Small to moderate-sized defects of the hand overlying joint surfaces, flexor tendons, Silastic implants, and tactile surfaces require full-thickness skin and subcutaneous tissue either for primary coverage or in anticipation of secondary reconstruction. In this report, six difficult hand wounds are resurfaced with an arterialized island pedicle from the lateral surface of the nearby digit in lieu of multistage distant pedicle flaps. The Littler neurovascular island flap has been modified to include only the digital artery and venae comitantes at its pedicle, preserving digital nerve intact in the donor digit. Microsurgical separation of the digital artery from the digital nerve minimizes the sensory loss of the donor digit. Cortical reeducation at the recipient site is unnecessary. The lengthy pedicle allows an arc of coverage over the palm, dorsum of the hand, and adjacent digits. Results in six cases have been favorable. Flap survival has been 100 percent. Maximum flap size was 5.5 X 2.5 cm. Two-point discrimination of the donor defect averaged 4.5 mm. No significant donor morbidity was noted, with the exception of one case in which there was a mild degree of hypertrophic scarring across the volar aspect of the proximal interphalangeal joint. The one-stage procedure minimizes the number of hospitalizations and disability time. Its proximity to injury, versatility, and relative speed with which it can be raised encourages its usage for primary coverage (two cases in this series). Preservation of near normal two-point discrimination of the donor site allows either the radial or ulnar surface of the nearby digit to be used.