Repair of Soft Tissue Defect of the Finger Using the Heterodigital Neurocutaneous Island Flap

The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal digital island flap can be used for repairing the defect of adjacent finger, but the limited length of the pedicle precludes its use for a more distal defect. The heterodigital neurocutaneous island flap of the dorsal branch of the digital nerve can be used as an alternative to resolve this problem.

Study Overview

• Status: Completed
• Conditions: Sensory Reconstruction of the Volar Aspect of the Finger; The Heterodigital Neurocutaneous Island Flap
• Intervention / Treatment: Device: the neurocutaneous island flap

Detailed Description

At final follow-up, we measured the sensibility of the flaps using the Semmes-Weinstein monofilament test and the static 2-point discrimination test. The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stopped at 4mm as a limit of 2PD and considered this normal.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Hebei
    • Tangshan, Hebei, China, 063000
      • The Second Hospital of Tangshan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 60 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• the soft tissue defects involving the middle phalanx, the proximal interphalangeal joint, or both;
• a defect greater than or equal to 2 cm in length;
• a patient between 15 and 60 years of age.

Exclusion Criteria:

• concomitant injuries to the dorsal skin of the middle phalanx of adjacent finger that precluded its use as donor site;
• injuries to the course of donor nerve branch;
• a defect less than 1.5 cm in length;
• a fingertip or pulp defect;
• a soft tissue defect of the thumb.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Surgical flap; The neurocutaneous island flap is based on the dorsal branch of the digital nerve	Device: the neurocutaneous island flap; The neurocutaneous island flap of the dorsal branch of the digital nerve can be used for repair the defects of the proximal and middle phalanxes of adjacent fingers.; Other Names: dorsal digital island flap

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Discriminatory Sensation of the Flap	Discriminatory sensation of the flap is evaluated with the Static 2-point Discrimination Test. The test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent <6 mm; good 6-10 mm; fair 11-15 mm; poor >15 mm. The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stop at 4mm as a limit of 2PD and considered this normal. These assessments take place at a single time point at the final follow-up.	18 months to 24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cold Intolerance	We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100).	18 months to 24 months

Collaborators and Investigators

• Sponsor: The Second Hospital of Tangshan
• Collaborators: Chinese PLA General Hospital

Publications and helpful links

General Publications

• Chen C, Zhang X, Shao X, Gao S, Wang B, Liu D. Treatment of a combination of volar soft tissue and proper digital nerve defects using the dorsal digital nerve island flap. J Hand Surg Am. 2010 Oct;35(10):1655-1662.e3. doi: 10.1016/j.jhsa.2010.07.011.
• Wang B, Zhao Y, Lu A, Chen C. Ulnar nerve deep branch compression by a ganglion: a review of nine cases. Injury. 2014 Jul;45(7):1126-30. doi: 10.1016/j.injury.2014.03.017. Epub 2014 Apr 3.
• Chen C, Tang P, Zhang L. Reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap. Injury. 2013 Nov;44(11):1607-14. doi: 10.1016/j.injury.2013.06.025. Epub 2013 Jul 18.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: January 25, 2013
• First Submitted That Met QC Criteria: January 28, 2013
• First Posted (Estimated): January 29, 2013

Study Record Updates

• Last Update Posted (Actual): February 14, 2024
• Last Update Submitted That Met QC Criteria: January 19, 2024
• Last Verified: May 1, 2012

More Information

Terms related to this study

• Keywords: Dorsal branch of the digital nerve;; dorsal digital artery;; dorsal digital island flap;; neurocutaneous island flap.
• Other Study ID Numbers: HBTS1301283; CHS1301-00146 (Other Identifier: Hebei Clinical Trail Committee)