Repair of Soft Tissue Defect of the Finger Using the Heterodigital Neurocutaneous Island Flap

Study Overview
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Brief Summary
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The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal digital island flap can be used for repairing the defect of adjacent finger, but the limited length of the pedicle precludes its use for a more distal defect. The heterodigital neurocutaneous island flap of the dorsal branch of the digital nerve can be used as an alternative to resolve this problem.

Detailed Description
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At final follow-up, we measured the sensibility of the flaps using the Semmes-Weinstein monofilament test and the static 2-point discrimination test. The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stopped at 4mm as a limit of 2PD and considered this normal.

Conditions
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Sensory Reconstruction of the Volar Aspect of the Finger, The Heterodigital Neurocutaneous Island Flap

Intervention / Treatment
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* Device: the neurocutaneous island flap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: the soft tissue defects involving the middle phalanx, the proximal interphalangeal joint, or both; a defect greater than or equal to 2 cm in length; a patient between 15 and 60 years of age. Exclusion Criteria: concomitant injuries to the dorsal skin of the middle phalanx of adjacent finger that precluded its use as donor site; injuries to the course of donor nerve branch; a defect less than 1.5 cm in length; a fingertip or pulp defect; a soft tissue defect of the thumb.

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Surgical flap<br>The neurocutaneous island flap is based on the dorsal branch of the digital nerve | Device: the neurocutaneous island flap<br>* The neurocutaneous island flap of the dorsal branch of the digital nerve can be used for repair the defects of the proximal and middle phalanxes of adjacent fingers.<br>* Other names: dorsal digital island flap;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discriminatory Sensation of the Flap | Discriminatory sensation of the flap is evaluated with the Static 2-point Discrimination Test. The test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent <6 mm; good 6-10 mm; fair 11-15 mm; poor >15 mm. The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stop at 4mm as a limit of 2PD and considered this normal. These assessments take place at a single time point at the final follow-up. | 18 months to 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cold Intolerance | We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100). | 18 months to 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dorsal branch of the digital nerve;, dorsal digital artery;, dorsal digital island flap;, neurocutaneous island flap.