Treatment of fingertip degloving injury using the bilaterally innervated sensory cross-finger flap.

Treatment of a fingertip degloving injury continues to be a challenge problem. This article reports repair of this type of injury using a modified cross-finger flap, including both dorsal branches of the digital nerves. From December 2007 to March 2010, the flap was used in 17 digits of 17 patients who had a fingertip degloving injury. There were 13 men and 4 women with mean age of 33 years. The injured fingers requiring reconstruction included 5 index, 6 middle, and 6 ring fingers. The mean size of the soft tissue losses was 4.2 × 1.9 cm. The mean flap size was 4.4 × 2.2 cm. Neurorrhaphy was performed between the dorsal branches harvested with the flap and the digital nerves of the injured finger. For comparison, we also collected a series of 28 patients who had a fingertip degloving injury treated with a cross-finger flap without nerve repair. In the study group, all flaps survived completely. At a mean follow-up of 23 months, the average score of static 2-point discrimination on the finger pulp was 7.2 mm. According to the visual analog scale, 12 patients had no pain, 4 reported mild pain, and 1 experienced moderate pain. Positive Tinel sign was found in only 1 reconstructed finger. Of the comparison group (mean follow-up, 22 months), the average static 2-point discrimination was 9.8 mm. On the basis of the visual analog scale, no pain, mild pain, and moderate pain were noted in 18, 7, and 3, fingers, respectively. Positive Tinel sign was found in 9 reconstructed fingers. The outcomes of the 2 groups were significantly different. The bilaterally innervated sensory cross-finger flap is an effective method for repairing the fingertip degloving injury. The authors suggest that double nerve repairs should be performed to improve the pulp sensation and reduce the incidence of the painful neuroma.