Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries

Abstract

Objective: The aim of this study was to evaluate the long-term clinical outcomes of innervated digital artery perforator (IDAP) flap in the treatment of patients with fingertip injuries. Methods: Eighty-three patients (93 fingers; 70 male, 13 female; mean age = 35.2 years, age range = 5-65) with fingertip injuries who underwent acute or late reconstruction with IDAP flap between 2011 and 2016 were retrospectively reviewed. The mean age was 35.2 (range = 5-65) years. Reconstructions performed in 85 fingers (91.4%) were acute, and 8 fingers (8.6%) were late. Hypersensitivity, cold intolerance, and patient satisfaction were questioned as subjective evaluation parameters. The objective patient outcome evaluations consisted of static two-point discrimination (s2PD) test, the Semmes-Weinstein monofilament (SWM) test, and range of motion of the reconstructed fingers. Results: The mean follow-up period was 33.1 (range = 12-62) months. The smallest flap size was 1.6 x 0.7 cm; the largest flap size was 4 x 2 cm. All flaps survived completely. There was no postoperative infection or donor site morbidity. Hyperesthesia was observed in 4 fingers (4.3%), of which 3 were mild and 1 was moderate. Eighteen patients (18 fingers, 19.3%) experienced mild cold intolerance on reconstructed fingertips. 75 patients (90.3%) were highly satisfied, and 8 patients (9.7%) were satisfied with functional and aesthetic results of their fingertip reconstructions. No range of motion limitation was observed in any joints of 90 fingers (96.8%). The s2PD in the flaps ranged from 2 mm to 6 mm (mean = 3.71 ± 0.97 mm), compared with 2 mm to 5 mm (mean = 2.73 ± 0.66 mm) on the contralateral hand. The SWM test results of the flaps ranged from 2.44 to 4.56, compared with 2.44 to 4.31 on the contralateral hand. The difference regarding s2PD and SWM test was statistically significant (P < 0.001). Conclusion: IDAP flap seems to be a sensate, reliable, and versatile flap that can be used in acute and late reconstructions of any type of fingertip defects. Satisfactory functional and aesthetic results can be achieved with better sensorial results and lower complication rates compared to other conventional reconstruction techniques. Level of Evidence: Level IV, Therapeutic Study.