RESURFACING OF THUMB-PULP LOSS WITH A HETERODIGITAL NEUROVASCULAR ISLAND FLAP USING A NERVE DISCONNECTION RECONNECTION TECHNIQUE/

The problems of late deterioration of sensation and a ''double sensibi lity'' phenomenon, either in the thumb or donor finger, are a known de ficiency of the conventional heterodigital neurovascular island flap. This is probably related to unsatisfactory cortical reorientation foll owing flap transfer. To obviate this problem, the authors have used a disconnection/reconnection technique for heterodigital island flaps in 17 patients, to resurface detects in the skin of the thumb. All patie nts were followed-up for 1 year, while 15 were followed-up for 2 years or more. There were no flap complications or Failures, and the length of the thumb tip was preserved in all cases. The classic two-point di scrimination was less than 6 mm in eight of these patients, and the re maining nine patients had two-point discrimination of between 6 and 8 mm. This technique was found to provide sensitive, supple, and well-va scularized skin with proper cortical representation, to replace the lo ss of the tactile pulp of the thumb tip in one operative stage.