The incidence and severity of the cold intolerance after reverse homodigital dorsoradial flap for coverage of thumb tissue defect

Abstract

Background: The reverse homodigital dorsoradial flap (RHDF) has been an optional treatment for thumb soft tissue defects. The current study aims to investigate the incidence and severity of cold intolerance after the use of the RHDF for thumb soft tissue reconstruction.

Methods: 49 patients with thumb soft-tissue defects treated with RHDF from 2010 to 2018 were included with the mean follow-up time of 36 (range, 14-61) months. The assessment of sensory recovery in the flap, the Cold Intolerance Symptom Severity (CISS) questionnaire, symptoms triggering temperature grade, and natural history of the symptoms were included in the final follow-up.

Results: 35 out of 49 patients (71.4%) reported cold intolerance. The mean CISS score of 35 cases was 28 (range 3-72) points. The mean age of the intolerance group was significantly older than that of the non-cold intolerance group. The incidence of cold intolerance in the dorsum was significantly lower than in the pulp and tip. Significantly positive correlations were presented between CISS scores and temperature grades of symptoms triggered. Seven patients were with partial recovery while 6 patients were with complete recovery from negative symptoms. 22 patients reported no change in terms of the symptoms.

Conclusions: Cold intolerance is a common complication after the RHDF for thumb tissue reconstruction, especially in the elderly population. Cold intolerance following RHDF warrants more attention for surgeons to describe the patient expect after the procedure.