Comparison of Innervated and Non-innervated Free Glabrous Skin Flap Transfers for Volar Digital Defect Reconstructions - A patient-reported Outcome Study
Notice bibliographique
Résumé
Soft tissue defects of the volar digits can be challenging to reconstruct. Toe pulp flaps and medialis pedis flaps are two commonly used flaps for volar digital soft tissue reconstruction, each with its advantages and disadvantages. Toe pulp flaps offer similar anatomical features to the pulp of fingers and thumbs, and digital nerves can be coapted for flap innervation. (1,2) However, toe pulp flaps require more donor site management, which may result in complications such as numbness, pain, and hypersensitivity. Medialis pedis flaps, on the other hand, provide glabrous skin for reconstruction, which minimizes donor site morbidity. (2) Nevertheless, medialis pedis flaps are not innervated and may not provide adequate sensory recovery. The purpose of this study was to compare the functional outcomes, sensibility, and subjective complaints of patients who received either toe pulp flaps or medialis pedis flaps for volar digital soft tissue reconstruction. This study aimed to provide evidence-based guidance on selecting the most suitable flap for volar digital soft tissue reconstruction. A total of 101 patients who underwent toe pulp flap or medialis pedis flap reconstruction for volar digital defects between 1998 and 2017 were included in this study. Patient-reported outcomes were evaluated by three questionnaires, including the Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Development of the Foot and Ankle Disability Index Questionnaire (FADI). Sensory recovery was evaluated by static two-point discrimination test (s2PD), moving two-point discrimination test (m2PD), and Semmes-Weinstein monofilament (SWM) test. Donor and recipient site subjective complaints were also collected, and the donor site scars were evaluated by the Vancouver Scar Scale. The results showed that both the toe pulp flap and medialis pedis flap reconstruction provided satisfactory patient-reported functional outcomes and comparable sensory recovery. No significant difference was observed in the sensory recovery between the two groups, although toe pulp flaps were innervated with digital nerves. However, donor site discomfort was more common in the toe pulp flap group, which was mainly due to the use of skin grafts for donor site closure. The medialis pedis flap can be preferred for defects with a width greater than 1.5 cm to avoid skin graft reconstruction to the donor site. In conclusion, the toe pulp flap and medialis pedis flap are both feasible for volar digital soft tissue reconstruction. The choice of the flap should be based on the defect size and the preference of the surgeon. References: 1. Lin, C. H., Lin, Y. T., Sassu, P., Lin, C. H., Wei, F. C. Functional assessment of the reconstructed fingertips after free toe pulp transfer. Plastic and Reconstructive Surgery 2007;120:1315-1321. 2. Koshima, I., Inagawa, K., Urushibara, K., Okumoto, K., Moriguchi, T. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000;105:1666-1674. 3. Tsai, F. C., Cheng, M. H., Chen, H. C., Wei, F. C. Microsurgical medialis pedis flaps for reconstruction of soft-tissue defects in the hand. Ann Plast Surg 2002;48:41-47.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».