Comparison of Innervated and Non-innervated Free Glabrous Skin Flap Transfers for Volar Digital Defect Reconstructions - A patient-reported Outcome Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".