Digital Artery Perforator Adiposal Flaps for Protective Coverage of Injured and Scarred Digital Nerves
Masato Hukuyama, MD1; Kiyohito Takamatsu, MD, PhD1; Akira Kawabata, MD1; Yasunari Awa, MD1; Takuya Yokoi, MD2; Kosuke Shintani, MD2; Ema Onode, MD2; Takuya Uemura, MD, PhD2; Mitsuhiro Okada, MD, PhD2;
1Yodogawa Christian Hospital, Osaka, Japan, 2Osaka City University Graduate School of Medicine, Osaka, Japan
Introduction: For treatment of scarred digital nerves in the past, neurolysis was the only surgical option. In treatment of digital nerve rupture, the most common surgical procedure is only to repair digital nerve without any attempt to cover the repaired nerve. After repair of a digital nerve injury, some patients complain of persistent numbness, pain, tenderness and severe Tinel’s sign-like symptoms.However, re-entrapment or re-adhesion of the digital nerve is possible even after neurolysis or digital nerve repair, and there are no commonly accepted interventions, such as the use of radial artery perforator adiposal flaps for median nerve, to prevent these complications. This study aimed to determine a therapeutic strategy using digital artery perforator (DAP) adiposal flaps to cover scarred or injured digital nerves.
Materials & Methods: Patients (n = 12, females, n = 3 and males, n = 9) were diagnosed with digital nerve adhesion (n = 3) or digital nerve rupture (n = 9). The average patient age was 43.3 years (range, 20-63 years). We used preoperative mapping of DAP using color Doppler ultrasonography. Neurolysis was performed in all patients with digital nerve adhesion, and the digital nerves were repaired in those with digital nerve rupture. Following these procedures, to prevent re-entrapment and re-adhesion, DAP adiposal flaps were elevated and transferred to cover the digital nerve lesion. The size of DAP adiposal flaps ranged from 5 x 8mm to 10 x 20 mm (averaged 72.2 mm2). After DAP coverage, symptoms, VAS at rest and VAS of tenderness were evaluated.
Results: In cases of digital nerve adhesion, all patients reported symptomatic improvement and no patient reported worsening of symptoms. however, in one of the three patients some subjective paresthesias persisted. At the final follow-up, all patients reported no obvious numbness or pain, indicating the re-adhesion or re-entrapment around nerves. In patients treated with digital nerve repair, the Tinel’s sign-like symptoms were considerably reduced at the repaired sites. The VAS scores of pain at rest were averaged 32/100 mm at two weeks post operation and 3/100 mm at final follow up. And the VAS scores of tenderness on the repaired sites were 37/100 mm and 0/100 mm respectively.
Conclusions: The DAP adiposal flap is suspected useful for covering scarred or injured digital nerves to
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