Aesthetic and Functional Reconstruction of Fingertip and Pulp Defects With Pivot Flaps

Purpose Sensate reconstruction with glabrous skin is essential for ideal resurfacing of fingertip and pulp defects. The purpose of this study was to examine the palmar pivot flap as a reconstructive option for fingertip and pulp defects. Methods We used the palmar pivot flap to repair fingertip and pulp defects in 21 consecutive patients. Outcomes measured included range of motion of the distal interphalangeal and proximal interphalangeal joints, sensation, pain, cold intolerance, and percussion tenderness. We assessed patient satisfaction with the aesthetic outcome using the Michigan Hand Outcomes Questionnaire. Results All flaps survived. We achieved complete mobility at the distal interphalangeal and proximal interphalangeal joints. Sensory recovery was demonstrated in all flaps within 2 weeks postoperatively. No painful tips were reported at an average follow-up of 11 months. All flaps had mild cold intolerance, and 1 patient reported mild percussion tenderness. All patients were satisfied with the appearance of the reconstructed fingertips. Conclusions The palmar pivot flap can provide sensate glabrous skin for the effective reconstruction of fingertip and pulp defects, resulting in aesthetically pleasing and good functional outcomes. (J Hand-Surg 2012;37A:1806-1811. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)