The pulp switch flap: an option for the treatment of loss of the dominant half of the digital pulp.

The fingertip has an important role in bi-digital pinch quality, and pulp loss is common and difficult to solve. The pulp switch consists of a pulp island flap with a homodigital neurovascular pedicle, vascularized by the palmar digital artery of the non-dominant pulp transposed to the dominant pulp side. We report the results in 16 patients treated for loss of the dominant half of a digital pulp from January 2000 to December 2008. On review after a minimum of 6 (range 6-18) months, the Weber's test demonstrated an average of 8 mm in static 2 point discrimination test for all digits, except the ring finger. In the monofilament Semmes-Weinstein test, we obtained a score of 3.61 for the thumb and little fingers, and 4.31 for the other fingers. We did not find partial or total necrosis of the flap. The pulp switch flap gave satisfactory functional results for viability, sensitivity, and digital mobility providing a sensate bi-digital pinch with acceptable aesthetic results in a single surgical procedure.

Adipofascial turnover flap for the coverage of the dorsum of the thumb: an anatomic study and clinical application.

The purpose of this report is to show how our anatomical findings have influenced the design of the dorsal homodigital adipofascial turnover arterial flap to the thumb. Thirty-six thumbs from 18 fresh cadavers were dissected at the Fèr à Moulin Laboratoire (Paris, France) between January 1998 and March 1999. All branches of the proper digital artery (PDA) were identified. During the clinical study, from 2002 to 2008, 12 patients with dorsal thumb skin defects were treated with adipofascial turnover flaps. The dorsal branches of the PDA typically emerge at the level of the metacarpophalangeal and interphalangeal joints, 10 mm apart from the joint line. Based on the anatomical study, the flap could be designed predictably and reliably. The main advantages of dorsal adipofascial turnover flaps include their simplicity; the possibility of a one stage procedure; avoiding the use of tissue from elsewhere on the limb/body; minimal donor-site deformity; and avoidance of damage to the volar digital arteries.

Dorsal forearm adipofascial turnover flap among the elderly.

We have assessed the results of soft tissue cover on the back of the hand using an adipofascial turnover flap. From 2004 until 2007, 14 patients (mean age: 62 years) underwent reconstruction of extensive defects in the dorsum of the hand, using a forearm adipofascial turnover flap based on the perforators of the anterior interosseous artery covered with a split skin graft. The pivot point of the flap is typically 4-6 cm proximal to the level of the radial styloid process. In 93% of patients, the reconstruction healed without any problem. The adipofascial turnover flap is a useful and reliable method of reconstruction of the dorsum of the hand even in elderly patients.