The purpose of this study was to compare two therapies for the reconstruction of digital Pulp defects: direct and reverse flow island flaps.
A randomized prospective study of 122 patients was performed with the loss of a digital pulp substance in one finger. Patients were divided into direct flow island flap (n = 62) or reverse flow island flap (n = 60) groups. A subgroup of patients in the reverse flow island flap group underwent end-to-end microsurgical suturing of the digital nerve on the contralateral aspect of the same digit with that of the flap. Postoperative sensory function and range of motion were evaluated. The authors conclude that the direct island flap resulted in motion loss at both PIP and DIP joints but had better discriminatory sensation in comparison with the reverse flap group.
Many reconstruction options are available for the coverage of distal soft tissue pulp loss, each of which carries inherent advantages and limitations. The homodigital island flaps carry the benefits of being a single procedure with the potential of providing excellent sensation. This report compared a single surgeon experience with these flaps in a prospective randomized fashion. From the results one can conclude that the direct flow flap yields better sensation at the expense of decreased PIP and DIP range of motion. The authors comment that the observed decreased ROM did not result in significant functional loss. The reverse flow flap had significantly less articular range of motion loss; however, was not as sensate. Based on these findings, the homodigital vascularized island flaps can be considered as a viable choice in distal pulp soft tissue reconstruction in experienced hands as these procedures are technically challenging.