Comparing Innervated and Noninnervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes

Background: Volar soft-tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compared innervated toe pulp (TP) and noninnervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes. Methods: Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at the authors’ institution for volar digital soft-tissue injuries, comprising 75 TP flaps and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire; Disabilities of the Arm, Shoulder and Hand Questionnaire; Foot and Ankle Disability Index; and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis used the Mann-Whitney U test and Pearson correlation coefficients. Results: The study cohort included 29 participants (TP, n = 15; MP, n = 14) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP flaps and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP flap group. Conclusions: TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and noninnervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects. (Plast. Reconstr. Surg. 155: 874e, 2025.)