The Use of a Neurotized Arterio-venous Flow-through Flap for Concurrent Pulp Revascularization and Reconstruction

Digital fingertip soft tissue defects requiring both reconstruction and revascularization pose challenges to the reconstructive surgeon. Traditional options, including terminalization, vein graft and cross-finger flap, and free flow-through flaps, maybe unsuitable or unavailable, with potential for significant donor site morbidity. Venous free flaps rely on venous circulation alone, with no sacrifice of an artery. We present a unique case of a self-employed tradesman with Raynaud’s disease, with four-finger injury, and three-finger ischemia for whom we performed a neurotized arterialized venous flow-through flap to revascularize and reconstruct a pulp defect (with a concomitant vessel gap of 2 cm). After allowing for a period of intrinsic delay, the neurotized arterialized venous flow-through flap was inset after 10 days. The flap survived and the patient began to return to his activities within a month of the injury.