Microsurgical reconstruction of sensory skin

Loss of sensory function is a severe impairment for the hand which loses a lot of its dexterity, becomes "blind" if not guided by sight and is susceptible to burns, wounds and infections. Nerve repair by sutures or grafts is the preeminent operation if the condition of the skin is good. When skin is damaged, various sensory flaps (both free microvascular and local pedicle) may be used. Island flaps from the pulp of another digit give inconsistent results. Sensory flaps from the back of the index finger to the thumb give a fair two-point discrimination. Free microvascular flaps from the pulp or the web of the hallux or from two or even three toes are safe and good operations which restore both perfect skin coverage and excellent sensory function with good two-point discrimination. The damage at the donor site is well tolerated. When previous operations have covered the digit or the hand by means of non-sensory skin, direct neurotization of this skin is possible. Research has been done in animals showing the formation of free endings inside the neurotized skin. Rehabilitation of the previously existing sensory corpuscles is even possible. Our series includes 12 island flaps from the pulp, 19 pedicle flaps from the dorsum, 17 homodigital reverse flow flaps, 38 different types of free neurovascular flaps from the foot and 3 direct sensory neurotization.