Comparison Of The Clinical Efficacy Of The Free Tibial Flap Of The Second Toe And Reverse Homodigital Artery Island Flap With Neural Anastomosis For Repairing Finger Pulp Defects

ObjectiveTo observe and compare the clinical efficacy between the free tibial flap of the second toe and reverse homodigital artery island flap with cutaneous branches of proper digital nerve for repair of the finger pulp defects.MethodsFrom March 2014 to June 2020,50 patients with 2nd to 5nd finger pulp defects were retrospectively analyzed,of which 25 cases(25 fingers)were repaired with free tibial flap of the second toe(the free flap group)and 25 cases(25 fingers)were repaired with reverse homodigital artery island flap with cutaneous branches of proper digital nerve(the digital artery group).Patients received the same sensory rehabilitation training.The follow-up time for all patients ranged from 12 months to 30 months,with an average of(15.9 ± 3.6)months.The data of perioperative period and follow-up results were compared between the two groups.The follow-up includes patient satisfaction of flap appearance,range of motion(ROM)of injured finger,s2-PD(statistic two-point discrimination),and sensory grade(S0 to S4).Cold intolerance of injured finger was assessed by Cold Intolerance Symptom Severity(CISS)score questionnaire.ResultsThe surgery was completed successfully in both groups,and no serious intraoperative complications occurred in either group.No statistical differences were found between the 2 groups in intraoperative bleeding,incisional healing grade,and length of hospital stay(P>0.05).The free flap group underwent longer surgery time than the digital artery group(P<0.05).Patients in both groups were followed up for more than 12 months,and there was no statistical difference between the two groups in terms of time to return to sensory retraining and time to work(P>0.05).At the last follow-up,the free flap group achieved better s2-PD and CISS score(P<0.05).No statistical differences were found between the 2 groups in appearance of the flaps,satisfaction of patients and ROM of the affected fingers(P>0.05).In terms of sensory grade,the free flap group achieved S3+in 8 cases(8 fingers),S4 in 17 cases(17 fingers)and the digital artery group achieved S3+in 18 cases(18 fingers),S4 in 7 cases(7 fingers).ConclusionThe lateral ventral flap of the toe and the reverse homodigital artery island flap are both commonly used to reconstruct the finger pulp with satisfactory clinical results.Despite the longer operative time and more demanding microscopic technique,the reconstruction of the finger pulp with free tibial flap of the second toe had better recovery of finger cold tolerance and pulp sensation than that of reverse homodigital artery island flap with cutaneous branches of proper digital nerve.