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20-05-2012 | Surgery | Article

Arterialized venous sensate flap feasible for finger pulp surgery


Free abstract

MedWire News: The use of an arterialized venous sensate flap is an effective alternative for finger pulp reconstruction, research shows.

In contrast with an insensate flap, use of the sensate venous flap allowed nearly all patients to achieve normal sensation.

Patients in the sensate group also returned to work earlier than those in the insensate group, "which indicates that sensation regaining is crucial in the functional recovery of the fingertip," report Cunyi Fan (Shanghai Jiaotong University, China) and colleagues.

The reconstruction of digital pulp in hand injuries has traditionally been a challenge for hand and reconstructive surgeons. To align with the surgical principle of "replace like with like," the free toe pulp is often considered an optimal choice.

Other surgeons have achieved success with the arterialized venous flap in clinical practice, however. Unlike conventional arterial flaps, venous flaps do not sacrifice the artery, do not require deep dissection, and can be harvested as a sensate flap to restore peripheral nerve function.

As described in the Journal of Plastic, Reconstructive, and Aesthetic Surgery, the researchers investigated the feasibility of finger pulp reconstruction using arterialized venous flaps taken from the forearm.

Fifteen patients were treated with sensate flaps and 12 with insensate flaps. The size of the flaps was 30x23 mm in the sensate group and 32x22 mm in the insensate group, with all the flaps surviving completely.

Patients in both surgical arms achieved almost a full range of motion in the reconstructed finger, with a slight nail deformity in three patients receiving the sensate flap and in two patients in the insensate group.

Importantly, almost all of the flaps in the sensate arm obtained normal sensation, including in the static two-point discrimination test. By contrast, most cases of the insensate group achieved only poor results.

The Semmes-Weinstein monofilament test revealed that just two patients in the sensate group had a diminished response to touch, whereas 75% of the insensate patients had a diminished protective touch response and a loss of protective sensation.

"Despite poor sensation recovery in the insensate group, the pinch power was not dramatically reduced," note the researchers.

Cold intolerance was observed in most of the insensate patients, including two severe cases, while only one patient in the sensate group reported cold intolerance.

On average, patients receiving the venous sensate flap returned to work 6 weeks earlier than patients who received the insensate flap.

By MedWire Reporters

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