Back to 2026 Abstracts
Finger Pulp Reconstruction Using Reverse Homodigital Artery Island Flap with Palmar Cutaneous Branches of the Digital Nerve: Case Series and Technical Considerations
Dun-Hao Chang, MD
Taipei Veterans General Hospital, Taipei, Taiwan
Background:The reverse homodigital artery island flap is an axial-pattern skin flap based on a vascular pedicle from the proximal phalanx, offering one-stage reconstruction for distal finger defects. However, traditional techniques often omit nerve coaptation, potentially resulting in impaired sensation. This study presents a case series evaluating clinical outcomes of reverse digital artery island flaps with coaptation of the palmar cutaneous branches of the digital nerve for finger pulp reconstruction.
Methods:Between January 2021 and March 2025, eight patients with fingertip pulp defects underwent reconstruction using the reverse digital artery island flap. In five cases, the terminal digital nerve stump was coapted to the palmar cutaneous branches of the digital nerve within the flap. The remaining three patients underwent conventional flap transfer without nerve repair. Postoperative outcomes, including complications, were recorded. Sensory recovery was assessed at six months postoperatively using static two-point discrimination (2PD) and the Semmes-Weinstein monofilament (SWM) test. Aesthetic outcomes were evaluated using a 10-point visual analogue scale (VAS) scored independently by two plastic surgeons.
Results:All patients were male, with a mean age of 48.1 ± 18.3 years. All flaps survived completely. One patient developed moderate flexion contracture, which required scar release at four months postoperatively. The nerve coaptation group demonstrated improved sensory recovery (2PD: 7.6 ± 3.6 mm vs. 10.0 ± 1.0 mm; SWM: 3.84 ± 0.4 vs. 4.44 ± 0.18), though the differences did not reach statistical significance. Aesthetic outcomes were satisfactory in all cases, with a mean VAS score of 8.9 ± 1.2.
Conclusions:The reverse homodigital artery island flap is a reliable and effective option for finger pulp reconstruction, offering favorable aesthetic and functional outcomes with low complication rates. Incorporating sensory nerve coaptation via the palmar cutaneous branches of the digital nerve may enhance sensory recovery and should be considered as part of the standard reconstructive approach.
Back to 2026 Abstracts
