Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap.

PURPOSE: This study investigates the use of homodigital reverse dorsoradial flap with neurorrhaphy for thumb soft tissue defect.

METHODS

From 1996 to 2010, the homodigital dorsoradial flap was performed on seven adult patients and one 3-year-old boy. The flaps ranged from 1.2 to approximately 3.0 cm × 2.0 to approximately 4.2 cm in size. In six of the eight patients, the dorsal collateral branch of the radial nerve supplying the flap was also included in the pedicle and coapted to the proper digital nerves of the thumb. At final follow-ups, flap sensation, thumb motion, and donor-site morbidity were assessed.

RESULTS

All flaps survived completely. At final follow-up of 8.5 months (range, 3 to 14 months), all patients except the 3-year-old child (who could not express clearly) reported satisfactory sensory recovery, with the static two-point discrimination ranging between 6 and 12 mm (mean, 9.4 mm). Range of motion of the metacarpophalangeal and interphalangeal joints of the thumbs was also preserved with minimal donor-site morbidity in all cases.

CONCLUSIONS

Innervated reverse homodigital dorsoradial flap serves as a reliable and sensate flap for extensive thumb soft tissue reconstruction.