Application of medial plantar venous flap with sensory nerves in the treatment of distal digital pulp defects

Abstract

Objective To investigate the clinical application and efficacy of medial plantar venous flap with sensory nerves for repair of distal digital pulp defects. Methods From May 2015 to October 2018, 14 cases (21 fingers) of distal digital pulp defects were treated by the medial plantar venous flap with sensory nerves. The defect area ranged from 1.8 cm×0.6 cm to 2.9 cm×2.1 cm. The flap was designed to contain at least one medial cutaneous branch of saphenous nerve or medial cutaneous branch of plantar nerve. The donor area was covered with full-thick skin graft or directly sutured. Results All the flaps survived. All the grafts in the donor area achieved primary healing. The scar flexion contracture deformity of fingers occurred in 2 cases, and the motion degree of distal interphalangeal joint was more than 60°. The postoperative follow-up time ranged from 4 to 22 months with an average of 12 months. The appearance of the flap was good, and the color and texture were similar to those of the surrounding skin. The flap two-point discrimination was 6.0 to 8.0 mm, with an average of 6.8 mm. According to the upper extremity functional evaluation criteria issued by the Hand Society of the Chinese Medical Association, the finger active motion was rated as excellent in 16 fingers, good in 3 fingers and fair in 2 fingers. According to the sensory evaluation standard issued by British Medical Research Council (1954), the sensory function of flap was S4 in 15 fingers, S3 in 5 fingers and S2 in 1 finger. Conclusion The medial plantar venous flap with sensory nerves is similar to the finger in appearance and texture. It can repair the damaged nerve, reconstruct the sensation and function of the digital pulp, and obtain better clinical efficacy. Key words: Finger injuries; Surgical flaps; Sensory nerve; Venous flap