Publication:

Outcome of heterodigital neurovascular island flap for reconstruction of pulp defect of thumb

Background The reconstruction of thumb pulp defects requires durable coverage and fine sensibility restoration. The heterodigital neurovascular island flap offers glabrous, sensate tissue and is widely used, although local outcome data are limited.

Methods This prospective observational study was conducted at the National Institute of Burn and Plastic Surgery, Dhaka, from January 2023 to June 2024. Thirty patients with thumb pulp soft-tissue defects underwent reconstruction using a heterodigital neurovascular island flap. Outcomes assessed included flap viability, donor site morbidity, sensory recovery and patient satisfaction. Data were analyzed using SPSS version 26.0.

Results The mean age was 30.7±12.3 years; most patients were male (83.3%). Trauma was the leading cause (86.7%) and most defects exceeded 5 cm² (53.3%). Flap survival was favorable, with 80% uneventful cases; minor complications included marginal necrosis (10%) and infection (6.7%). Donor site morbidity was low (76.7% uneventful). All patients regained pain sensation by day 5 and 66.7% regained tactile sensation by day 14. Mean static two-point discrimination improved from 4.65±0.46 mm at 3 weeks to 3.70±0.59 mm at 3 months, approaching the contralateral thumb (3.33±0.61 mm; p=0.02). Good outcomes were observed in 80% of cases, with high patient satisfaction (83.3%).

Conclusions The heterodigital neurovascular island flap is a reliable technique for thumb pulp reconstruction, providing satisfactory sensory recovery, high flap survival and minimal complications.