Functional Assessment of Transplanted Skin in Volar Defects of the Digits

A COMPARISON BETWEEN FREE GRAFTS AND FLAPS

¹ From the Plastic and Jaw Department, Royal Hospital Annexe, Sheffield, England

1. One hundred grafts or flaps applied to volar digital defects were examined with special reference to their sensory and autonomic reinnervation.

2. Sensation was better in cross-finger flaps and thenar flaps, and they gave an excellent cosmetic result. Their donor sites were not without minor complications,

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but these could be overcome in thenar flaps. Wolfe grafts were not as satisfactory but were an improvement on splint-skin grafts, which tend to be poorly innervated and to give a bad cosmetic result. Pectoral flaps were poorly innervated, probably because they were used to cover large defects and not because of any inherent quality in the donor skin.

3. It is suggested that for any given area of defect the thicker the donor skin the better the functional result and that for a given thickness of skin the sensation decreases with increased size.

4. Response to adrenaline showed that autonomic reinnervation was complete at two years, after which the sweating of pedicle flaps was related to recovery of sensation.

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