Reconstruction of Thumb Pulp Defects Using a Modified Kite Flap

• Published in: The Journal of hand surgery (American ed.) Vol. 36; no. 10; pp. 1597 - 1603
• Main Authors: Zhang, Xu, MD, Shao, Xinzhong, MD, Ren, Chunzhen, MD, Zhang, Zhijie, MD, Wen, Sumin, MD, Sun, Jianxin, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Diseases of the osteoarticular system; Dorsal digital nerve; dorsum of index finger; Female; first dorsal metacarpal artery; Humans; Male; Medical sciences; Middle Aged; modified kite flap; Orthopedics; Reconstructive Surgical Procedures - methods; Sensation; Soft Tissue Injuries - surgery; Surgical Flaps - innervation; Thumb - injuries; Thumb - innervation; Thumb - surgery; thumb pulp defect; Young Adult; first dorsal metacarpal artery; thumb pulp defect; dorsum of index finger; modified kite flap; Dorsal digital nerve; Substance loss; Anatomical reconstruction; Artery; Pulp; Metacarpal bone; Treatment; Surgery; Orthopedics; Flap (surgery); Index (finger)
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2011.06.033

Purpose We report on a modified kite flap for the reconstruction of thumb pulp defects. We performed nerve repair to improve thumb pulp sensation. Methods From May 2005 to December 2008, 42 thumbs in 42 patients were treated. The average size of the thumb pulp defects was 2.1 × 2.6 cm (range, 1.6 × 1.8 cm to 2.8 × 3.1 cm). The mean flap size was 2.5 × 2.9 cm (range, 1.8 × 2.2 cm to 3.2 × 3.5 cm). The radial branch of the second dorsal digital nerve was coapted to one of the proper digital nerves of the thumb. The required average length of the nerve branch was 1.2 cm (range, 0.7 to 1.6 cm). At follow-up, flap sensation was assessed using a static 2-point discrimination (2PD) test. For comparison, we also included 32 patients without nerve repair from April 2003 to April 2005. Outcomes were rated using the modified American Society for Surgery of the Hand Guidelines for Stratification of 2PD. Results In the study group, full flap survival was achieved in 40 thumbs, and partial distal flap necrosis was noted in 2 thumbs. At final follow-up (mean, 26 mo; range, 24 to 27 mo), we obtained a fair result, with a mean 2PD of 7.9 mm (range, 7 to 10 mm) on all flaps. In the comparison group without nerve repair, there were 26 fair and 6 poor results, with a mean 2PD of 12 mm (range, 8 to 18 mm) at final follow-up (mean, 24 mo; range, 22 to 26 mo). There was a highly significant difference between the 2 groups. Conclusions We suggest performing nerve repair to improve the sensation of the kite flap when reconstructing a thumb pulp defect. Type of study/level of evidence Therapeutic II.