Fatih DUYGUN, Cengiz ALDEMİR

Littler heterodigital neurovascular island flap applied to tissue defects of the distal thumb

To observe the results of Littler heterodigital island flap utilized in the treatment of pulpa defects of the thumb and evaluate our findings in the light of the literature. Twelve patients who applied to our clinic with defects on the distal tissue of the thumb between 2008 and 2016 were included in the study. Ten of the patients were male, 2 were female. Mean age was 40.25 years. Eight patients had tissue defects on their right 1st digital and 4 on their left. The sensory and functional outcomes and wound healing on the receiving site were evaluated. Additionally, we determined 2-point discrimination and cortical re-orientation. In all patients, the flap was healthy and no necrosis was observed. Mobility and stability of the thumb was optimal in all cases. In 2 patients, scar tissue development was observed at the donor site, but there was no functional deterioration. Sensory examination was normal in all patients. Mean value of 2-point discrimination was determined as 7 mm’s. Littler neurovascular island flap is an effective treatment which re-establishes sensory ability in distal thumb injuries with tissue loss

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1. Qin JZ, Wang PJ. Fingertip reconstruction with a flap based on the dorsal branch of the digital artery at the middle phalanx: a simple and reliable flap. Ann Plast Surg. 2012;69(5):526-8

2. Muzaffar AD, Chao JJ, Freidrich JB. Posttraumatic thumb reconstruction. Plast Reconstr Surg. 2005;116(5):103-22

3. Bang H, Kojima T, Hayashi H. Palmar advancement flap with V-Y closure for thumb tip injuries. J Hand Surg Am. 1992;17(5):933-4

4. Mutaf M, Temel M. Gunal E, Isik D. Island volar advancement flap for reconstruction of thumb defects. Ann Plast Surg. 2012;68(2):153-7.

5. Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg. 1982;72(5):688-97.

6. Adani R, Squarzina PB, Castagnetti C, Lagana A, Pancaldi G, Caroli A. A comparative study of the heterodigital neurovascular island flap in thumb reconstruction, with and without nerve reconnection. J Hand Surg Br. 1994;19(5):552-9.

7. Delikonstantinou IP, Gravvanis AI, Dimitriou Vasilios, Zogogiannis I, Douma Amalia, Tsoutsos DA. Foucher First Dorsal Metacarpal Artery flap versus littler heterodigital neurovascular flap in resurfacing thumb pulp loss defects. Annals of Plastic Surgery. 2011;67(2):119-22

8. E. Peraut, M.- P. Mirous, M. Chammas. Secondary restoration of fingertip sensation with littler’s heterodigital neurovascular island flap after ring avulsion injury: report of two cases. Chir Main. 2015;34(1):49-54.

9. Krag C, Rasmussen KB. The neurovascular island flap for defective sensibility of the thumb. J Bone Joint Surg Br. 1975;57(4):495-9

10. Hashem AM. Salvage of degloved digits with heterodigital flaps and full thickness skin grafts. Annals os Plastic Surgery. 2010;64(2):155-8