Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V–Y flaps for donor site repair

Abstract

Purpose: To assess the clinical value and feasibility of the dorsoulnar flap of the thumb combined with relay V–Y flaps for reconstruction of the thumb fingertip injuries. Methods: In this retrospective study, we retrospectively reviewed 20 patients (13 men, 7 women; June 2014–June 2016) with thumb fingertip defects who underwent reconstructive procedures with transfer of the dorsoulnar flap of the thumb. The average size of the defects ranged from 1.8 cm × 2.0 cm to 2.0 cm × 3.0 cm, whereas the reconstructed dorsoulnar flap of the thumb ranged in size from 2.0 cm × 2.2 cm to 2.2 cm × 3.0 cm. A V-Y flap was used to repair the donor site at the same time. Sensation within the reconstructed thumb, the aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work (RTW) time were measured. Results: All 40 flaps survived without necrosis. The follow-up period ranged from 6 to 24 months. There were no complications reported. The mean static two-point discrimination values at the reconstructed thumb fingertip and donor site were 8.5 mm (range 8–10 mm) and 12.5 mm (range 12–14 mm), respectively. The average visual analog scores for the aesthetic appearance of the recipient and donor sites were 8.4 (range 8–9.5) and 9.6 (range 9–10), respectively. The average Michigan Hand Outcome Questionnaire score for the reconstructed hand was 9.4 (range 6–16). The average RTW time was 9.8 weeks (range 6–13 weeks). All patients were satisfied with the aesthetic outcome. Conclusion: The dorsoulnar flap of the thumb is an ideal alternative for reconstruction of the thumb fingertip injuries, and a V-Y flap was suitable for repairing the donor site with a reduced incidence of complications.