OBJECTIVETo investigate the method and clinical outcome of reconstructing large pulp defects of the fingertips with a homodigital neurovascular island flap.

METHODSForm June 2007 to October 2009, 16 patients with the defects of pulp were repaired by the spiral flap that was a homodigital neurovascular island flap with a unique spiral advancement and transposition design allowed pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. There were 12 males and 4 females with an average age of 37 years ranging from 18 to 49 years. The defect were caused by machine crush injury 11 cases, pressure injury by heavy objects in 2 cases, crush injury by door of car 1 case, injury by saw in 2 cases. The defect was located in the index finger in 5 cases, the middle finger in 9 cases,the ring finger in 2 cases. All injuries had large pulp defects averaging 1.6 cm (long) x 1.2 cm (wide) to 2.5 cm (long) x 1.7 cm (wide). Short-term results for all patients were reviewed. Outcome measures included static 2-point discrimination, total active motion, and hypersensitivity or cold intolerance.

RESULTSAll flaps achieved primary healing with no complications. Sensory recovery was excellent with an average 2-point discrimination of 5.1 mm. All patients were followed-up for 8 to 20 months (averaged 12 months) with highly satisfactory with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance. According to the evaluation of total active motion (TAM) scales, the results were excellent in 7 cases, good in 8 cases (9 lesions) and fair in 1 case.

CONCLUSIONThe spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term functional and aesthetic results and high patient satisfaction.