The Use of a Neurotized Arterio-venous Flow-Through Flap for Concurrent Pulp Revascularization and Reconstruction

Abstract

Summary: Digital fingertip soft tissue defects requiring both reconstruction and revascularization pose challenges to the reconstructive surgeon. Traditional options, including terminalization, vein graft and cross-finger flap, and free flow-Through flaps, maybe unsuitable or unavailable, with potential for significant donor site morbidity. Venous free flaps rely on venous circulation alone, with no sacrifice of an artery. We present a unique case of a self-employed tradesman with Raynaud's disease, with four-finger injury, and three-finger ischemia for whom we performed a neurotized arterialized venous flow-Through flap to revascularize and reconstruct a pulp defect (with a concomitant vessel gap of 2 cm). After allowing for a period of intrinsic delay, the neurotized arterialized venous flow-Through flap was inset after 10 days. The flap survived and the patient began to return to his activities within a month of the injury.