Sensory reconstruction in different regions of the digits: A review of 151 cases

BackgroundSoft tissue defects of the digits are very common in hand trauma and can result in functional disability. The purpose of the study is to introduce the use of several modified and traditional sensate flaps to reconstruct different regions of the digits and to evaluate the efficacy of these techniques.MethodsA retrospective study was conducted with 151 patients who had soft tissue defects of the digits treated with the sensate flaps from February 2005 to March 2014. Based on different regions of the soft tissue defects, the patients in the study were divided into four groups [1]: thumb group treated with the dual-innervated and traditional kite flaps [2]; distal finger group treated with the single- and dual-innervated dorsal digital flaps [3]; proximal finger group treated with the heterodigital neurocutaneous island flap; and [4] awkward region group treated with the Litter flap. The main outcomes were static 2PD and Semmes-Weinstein monofilament scores of the flap, pain and patient satisfaction.ResultsSignificant difference was found between dual-innervated and traditional kite flaps, and between single- and dual-innervated dorsal digital flaps in static 2PD, pain and patient satisfaction (P < 0.05). Double nerve repairs presented better discriminatory sensation on the flap, lower incidence of pain in the injured digit and larger satisfaction degree than single nerve repair.ConclusionsCompared to single-innervated flap, dual-innervated flap exhibited better sensory recovery and lower pain incidence. Being an additional treatment option, Littler flap may be better choice for sensory coverage in some specific situations including border injuries.