Efficacy of Modified Antegrade Digital Artery-Nerve V-Y Island Flap and Bilateral Neurovascular Bundle-Bearing V-Y Island Flap in Repairing Distal Fingertip Defects: A Comparative Analysis.

[AIM] Fingertip defects are common injuries in hand surgery, and their functional reconstruction remains a clinical challenge. This study aims to compare the clinical efficacy of the modified antegrade digital artery-nerve V-Y island flap with that of the bilateral neurovascular bundle-bearing V-Y island flap in repairing distal fingertip defects.

[METHODS] This single-center retrospective study included 120 patients with distal fingertip defects treated between October 2021 and October 2024. Among them, 50 underwent repair using the modified antegrade digital artery-nerve V-Y island flap (group A), while 70 received the bilateral neurovascular bundle-bearing V-Y island flap (group B). Perioperative metrics (operative time, intraoperative blood loss, hospital stay duration), sensory function (static two-point discrimination [s2-PD], excellent/good rate based on S3+ grading), joint mobility (metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints), Michigan Hand Outcomes Questionnaire (MHQ) scores, peripheral circulation parameters (transcutaneous partial pressure of oxygen [TcPO], blood perfusion units [BPU]), and complication rates at 6 months postoperatively were compared between the two groups.

[RESULTS] Baseline characteristics showed no statistically significant differences between the two groups ( > 0.05). Group A had longer operative times than group B but demonstrated significantly lower intraoperative blood loss and shorter hospital stay ( < 0.05). At 6 months postoperatively, group A demonstrated superior s2-PD and a higher excellent/good rate based on S3+ grading ( < 0.05); however, there was no significant difference in joint mobility between groups ( > 0.05). Compared to group B, group A achieved significantly higher total MHQ scores and subscale scores for hand function, daily activities, work performance, aesthetic appearance, and patient satisfaction, as well as lower pain scores, at 6 months postoperatively ( < 0.001). Additionally, TcPO and BPU values were higher in group A ( < 0.001). No significant between-group difference in overall complication rates was observed ( > 0.05).

[CONCLUSIONS] Compared to the bilateral neurovascular bundle-bearing V-Y island flap repair surgery, the modified antegrade digital artery-nerve V-Y island flap repair surgery reduces intraoperative blood loss and shortens hospitalization time. This technique offers advantages in sensory recovery, overall hand function, patient satisfaction, and restoration of peripheral circulation without increasing the risk of complications. These results suggest its potential as a more effective reconstructive option for fingertip defects.