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Research Article| Volume 60, ISSUE 4, P356-359, April 2007

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Evaluation of moving and static two point discriminations of volar forearm skin before and after transfer as a sensate radial forearm island flap in reconstruction of degloving injury of the thumb

      Summary

      In degloving injury of the thumb the large skin defect needs cover with sensate, glabrous and pliable skin. Although coverage of this defect with a sensate free flap from the foot is the best choice, most commonly, cover is achieved using a non-sensate distant pedicle flap. Between 2001 and 2003, degloving injuries of the thumb in eight patients were reconstructed using a sensate radial forearm flap in the sensory territory of the lateral ante-brachial nerve of the forearm which was repaired to the digital nerve of the thumb (six cases) or to a branch of the sensory radial nerve (two cases). Follow-up period ranged from 17 to 41 months (mean: 29.9 months). Sensory evaluation was performed using the moving two point discrimination (M-2PD) and static two point discrimination (S-2PD) of the volar forearm skin. These altered significantly after transfer and their values approached those of the contra-lateral thumb but never reached normal sensation (p<0.01). Sensate radial forearm island flap is a reliable option to cover a large defect of the thumb such as degloving injury and the sensation produced is acceptable.

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      References

        • Heitmann C.
        • Levin L.S.
        Alternatives to thumb replantation.
        Plast Reconstr Surg. 2002; 110: 1492
        • Omokawa S.
        • Mizumoto S.
        • Fukui A.
        • et al.
        Innervated radial thenar flap combined with radial forearm flap transfer for thumb reconstruction.
        Plast Reconstr Surg. 2001; 107: 152
        • Beimer E.
        • Stock W.
        Total thumb reconstruction, a one stage reconstruction using an osteocutaneous forearm flap.
        Br J Plast Surg. 1983; 36: 52
        • Swartz W.M.
        Restoration of sensibility in mutilating hand injuries.
        Clin Plast Surg. 1989; 16: 515
        • Oetz G.
        • Giessler A.
        • Erdmann D.
        • et al.
        Soft tissue coverage in devastating hand injuries.
        Hand Clin. 2003; 19: 63
        • Wei F.C.
        • Colony H.
        Microsurgical reconstruction of opposable digits in mutilating hand injuries.
        Clin Plast Surg. 1989; 16: 427
        • Soutar D.S.
        • Tauner N.S.B.
        The radial forearm flap in the management of soft tissue injuries of the hand.
        Br J Plast Surg. 1984; 37: 18
        • Rui Y.
        • Shou K.
        • Zhang Q.
        • et al.
        Combined free-tissue transfer for primary reconstruction of radial part of the hand.
        Microsurgery. 2004; 24: 59
        • Yamauchi T.
        • Yajima H.
        • Kizaki K.
        • et al.
        Sensory reconstruction in sensate radial forearm flap transfer.
        J Reconstr Microsurg. 2000; 16: 593
        • Yajima H.
        • Kobata Y.
        • Kawamura K.
        • et al.
        Radial forearm flaps for reconstruction in hand surgery.
        Scand J Plast Reconstr Surg Hand Surg. 2004; 38: 112
        • Gucer T.
        • Coskunfirat O.K.
        Reverse radial forearm flap as a source of soft tissue and blood supply for thumb reconstruction.
        Ann Plast Surg. 2000; 44: 426-428
        • Foucher G.
        • VanGenechten M.
        • Merle M.
        Single stage thumb reconstruction by a composite forearm island flap.
        J Hand Surg. 1984; 9B: 245
        • Martin D.
        • Bakhach J.
        • Casoli V.
        • et al.
        Reconstruction of the hand with forearm island flap.
        Clin Plast Surg. 1997; 24: 33
        • Song R.
        • Gao Y.
        • Song Y.
        The forearm flap.
        Clin Plast Surg. 1982; 9: 21
        • Huang C.H.
        • Chen H.C.
        • Huang Y.L.
        • et al.
        Comparison of the radial forearm flap and the thinned anterolateral thigh flap for reconstruction of tongue defects: an evaluation of donor-site morbidity.
        Plast Reconstr Surg. 2004; 114: 1704
        • Jones B.M.
        • O'Brien C.J.
        Acute ischemia of the hand from elevation of a radial forearm flap.
        Br J Plast Surg. 1985; 38: 396
        • Yang D.
        • Morris S.F.
        • Tang M.
        • et al.
        Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications.
        Plast Reconstr Surg. 2003; 112: 1012
        • Jeng S.F.
        • Wei F.C.
        The distally based forearm island flap in hand reconstruction.
        Plast Reconstr Surg. 1998; 102: 400