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Open Access
CC BY 4.0 · Arch Plast Surg 2025; 52(06): 347-354
DOI: 10.1055/a-2690-1599
Hand/Peripheral Nerve
Original Article

Does Incorporation of the Dorsal Cutaneous Branch of the Proper Digital Nerve in Anterograde Neurovascular Island Flap Improve Outcomes? Results of A Retrospective Case Series

Autoren

  • Pervaiz M. Hashmi 

    1   Section of Orthopedics, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

  • Abeer Musaddique 

    2   School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan

  • Muhammad Ali 

    3   Department of Public Health, University of Bradford, Bradford, United Kingdom

  • Muhammad A.A. Khan 

    1   Section of Orthopedics, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

  • Muhammad Z.N. Khan 

    4   Department of Orthopedic Surgery, Hamdard College of Medicine and Dentistry, Karachi, Pakistan

  • Marij Zahid 

    5   Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan

Funding None.
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Abstract

Background

Fingertip injuries present a challenge for surgeons. Factors such as appearance, sensation, and grip strength influence the choice of procedure. The neurovascular island (NVI) flap is commonly used due to its reliability and favorable results. However, it can lead to reduced sensation and a limited range of motion, which are significant concerns.

Methods

This study analyzed 56 adult patients with 66 finger injuries treated with a modified NVI flap by a single surgeon. The flap is based on branches of the proper digital artery to the volar and dorsal skin, including two nerves in the resected flap. The FIOS score was used to assess long-term flap outcomes at follow-up. Patients with thumb injuries, incomplete records, or loss of follow-up were excluded.

Results

The study found that NVI flaps had a survival rate of 98%. Post-surgery, the patients' outcomes were assessed using the FIOS score, with 61 cases rated as “excellent,” 4 as “good,” and 1 as “fair.” During long-term follow-up, none of the patients experienced cold intolerance or sensory abnormalities, which is attributed to the inclusion of the dorsal cutaneous nerve in the flap.

Conclusion

In conclusion, the NVI flap procedure proved to be a reliable method for reconstructing fingertip pulp loss, offering long-term satisfactory outcomes. It provided good coverage with preserved sensation, dexterity, and preservation of finger length, meeting the patients' cosmetic expectations.

Keywords

neurovascular island flap - fingertip injuries - anterograde flap - pulp loss - fingertip injuries

Authors' Contributions

P.M.H.: Conceptualization (lead), investigation (supporting), supervision (lead), and writing.

A.M.: Formal analysis (lead), investigation (supporting), writing—original draft (supporting).

M.A.: Data curation (lead), methodology (lead), writing—original draft (supporting).

M.A.A.K.: Data curation (supporting), formal analysis (supporting), software (equal), visualization (lead), writing—review and editing (lead).

M.Z.N.K.: Data curation (equal), methodology (equal). M.Z.: writing—review and editing (lead), investigation (supporting).


Ethical Approval

The study has been approved by the hospital's Ethical Review Committee (2020-5329-14408).


Patient Consent

Informed consent was obtained from the patients for publication of this article and accompanying images.




Publikationsverlauf

Eingereicht: 13. Dezember 2023

Angenommen: 14. Juli 2025

Accepted Manuscript online:
26. August 2025

Artikel online veröffentlicht:
20. November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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