Scientific Article|Articles in Press

Comparison of Treatment Methods of Thumb-Tip Defects With Phalangeal Bone Exposure: Modified Heterodigital Neurovascular Island Flap Versus Free Lateral Great Toe Flap

Published:February 17, 2023DOI:


      Modified heterodigital neurovascular island flaps and free lateral great toe flaps are dependable methods for treating thumb-tip defects with phalangeal bone exposure. We retrospectively analyzed and compared the details and results of the two methods.


      This retrospective study included 25 patients with thumb injuries with phalangeal bone exposure treated between 2018 and 2021. Patients were categorized as per the following surgical methods: (1) modified heterodigital neurovascular island flap (12 patients, finger flap group) and (2) free lateral great toe flap (13 patients, toe flap group). The Michigan Hand Outcome Questionnaire, aesthetic appearance, Vancouver Scar Scale, Cold Intolerance Severity Score, static 2-point discrimination, Semmes-Weinstein monofilament, and range of motion of the metacarpophalangeal joint of the injured thumb were evaluated and compared. In addition, operation time, hospital stay, return-to-work time, and complications were recorded and compared.


      In both groups, the defect was successfully repaired, with no cases of complete necrosis. The 2 groups had similar mean scores in static 2-point discrimination, Semmes-Weinstein monofilament, range of motion, and Michigan Hand Outcome Questionnaire scores. The aesthetic appearance, scarring, and cold tolerance of the toe flap group were better than the finger flap group. The operation time, hospital stay, and return-to-work time in the finger flap group were shorter than the toe flap group. The finger flap group had 2 complications—a superficial infection and 1 case of partial flap necrosis. The toe flap group had 3 complications—a superficial infection, 1 case each of partial flap necrosis, and partial skin graft loss.


      Both treatments can achieve satisfactory results; however, they each have advantages and disadvantages.

      Type of study/level of evidence

      Therapeutic IV.


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        • Emerson E.T.
        • Krizek T.J.
        • Greenwald D.P.
        Anatomy, physiology, and functional restoration of the thumb.
        Ann Plast Surg. 1996; 36: 180-191
        • Thoma A.
        • Vartija L.K.
        Making the V-Y advancement flap safer in fingertip amputations.
        Can J Plast Surg. 2010; 18: e47-49
        • Wang H.
        • Yang X.
        • Chen C.
        • Wang B.
        • Wang W.
        • Jia S.
        Modified Littler flap for sensory reconstruction of large thumb pulp defects.
        J Hand Surg Eur Vol. 2018; 43: 546-553
        • Wang H.
        • Yang X.
        • Chen C.
        • Huo Y.
        • Wang B.
        • Wang W.
        Modified heterodigital neurovascular island flap for sensory reconstruction of pulp or volar soft tissue defect of digits.
        J Hand Surg Am. 2020; 45: 67 e61-67 e68
        • Yuan C.
        • Liu H.
        • Zhang H.
        • Wang T.
        • Gu J.
        Reconstruction of thumb pulp defects using free lateral great toe flaps.
        J Hand Surg Am. 2021; 46: 421 e421-421 e427
        • Pet M.A.
        • Ko J.H.
        • Vedder N.B.
        Reconstruction of the traumatized thumb.
        Plast Reconstr Surg. 2014; 134: 1235-1245
        • Liu H.
        • Regmi S.
        • He Y.
        • Hou R.
        Thumb tip defect reconstruction using neurovascular island pedicle flap obtained from long finger.
        Aesthetic Plast Surg. 2016; 40: 755-760
        • Novak C.B.
        • Mackinnon S.E.
        • Williams J.I.
        • Kelly L.
        Establishment of reliability in the evaluation of hand sensibility.
        Plast Reconstr Surg. 1993; 92: 311-322
        • Imai H.
        • Tajima T.
        • Natsuma Y.
        Interpretation of cutaneous pressure threshold (Semmes-Weinstein monofilament measurement) following median nerve repair and sensory reeducation in the adult.
        Microsurgery. 1989; 10: 142-144
        • Kim J.S.
        • Hong J.P.
        • Choi J.W.
        • Seo D.K.
        • Lee E.S.
        • Lee H.S.
        The efficacy of a silicone sheet in postoperative scar management.
        Adv Skin Wound Care. 2016; 29: 414-420
        • Chen H.H.
        • Huang T.C.
        • Hsu Y.C.
        • Chen H.C.
        Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale.
        J Plast Reconstr Aesthet Surg. 2021; 74: 3196-3211
        • Irwin M.S.
        • Gilbert S.E.
        • Terenghi G.
        • Smith R.W.
        • Green C.J.
        Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms.
        J Hand Surg Br. 1997; 22: 308-316
        • Chung K.C.
        • Pillsbury M.S.
        • Walters M.R.
        • Hayward R.A.
        Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.
        J Hand Surg Am. 1998; 23: 575-587
        • Lister G.
        The choice of procedure following thumb amputation.
        Clin Orthop Relat Res. 1985; 195: 45-51
        • Bickel K.D.
        • Dosanjh A.
        Fingertip reconstruction.
        J Hand Surg Am. 2008; 33: 1417-1419
        • Louis D.S.
        • Palmer A.K.
        • Burney R.E.
        Open treatment of digital tip injuries.
        JAMA. 1980; 244: 697-698
        • Littler J.W.
        The neurovascular pedicle method of digital transposition for reconstruction of the thumb.
        Plast Reconstr Surg (1946). 1953; 12: 303-319
        • Adani R.
        • Pancaldi G.
        • Castagnetti C.
        • Zanasi S.
        • Squarzina P.B.
        Neurovascular island flap by the disconnecting-reconnecting technique.
        J Hand Surg Br. 1990; 15: 62-65
        • Lee Y.H.
        • Baek G.H.
        • Gong H.S.
        • Lee S.M.
        • Chung M.S.
        Innervated lateral middle phalangeal finger flap for a large pulp defect by bilateral neurorrhaphy.
        Plast Reconstr Surg. 2006; 118: 1185-1193