Sensory function of the neurovascular island flap in thumb reconstruction: comparison of original and modified procedures.

A study was conducted to examine the sensory function of thumbs that were reconstructed using 2 procedures: the original Littler neurovascular island flap (NVIF) procedure and a modification of the NVIF procedure in which the divided nerve of the transferred island flap is sutured to the original nerve of the thumb. Twenty-one patients with a mean follow-up period of 4.6 years were examined. Nine patients were treated with the NVIF procedure and 12 with the modified NVIF procedure. Paresthesia was observed more frequently in the patients treated with the original NVIF procedure. The Semmes-Weinstein test and the static and moving 2-point discrimination examinations showed no significant difference between the 2 groups. The pulp writing test showed significantly better results for the patients treated with the modified NVIF procedure. The transferred pedicle flap was fully recognized as representing the thumb in the modified procedure. In the original procedure, however, the sensibility of the transferred pedicle flap was recognized as coming from the thumb in only 61% of the cases; furthermore, the original procedure carried an additional disadvantage in that sensibility of the transferred pedicle flap was recognized as coming from both the donor and recipient sites. Copyright 2000 by the American Society for Surgery of the Hand.