{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:01:59Z","timestamp":1791450119908,"version":"4.3.3"},"reference-count":21,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Injuries to the digital distal phalanx often result in functional impairments such as loss of grip and sensation, along with aesthetic challenges. Various reconstructive techniques, including the use of adipofascial flaps, have been explored to address these issues. The homodigital dorsal adipofascial reverse flap (HDARF) has demonstrated promising results in restoring both functionality and aesthetics. However, a comparative evaluation between adipofascial flaps and other commonly used techniques, such as V-Y advancement flaps and cross-finger flaps, remains limited. Objective: This retrospective study evaluates the long-term functional and aesthetic outcomes of adipofascial flap reconstructions for pulp defects, focusing on sensory recovery and patient satisfaction. Methods: Between 2010 and 2022, 20 patients (14 men, 6 women) with digital pulp defects underwent reconstruction using adipofascial flaps in a single-stage procedure. Injuries included avulsion and crush injuries, distributed across various digits. Sensory recovery was assessed using the Semmes\u2013Weinstein monofilament test and two-point discrimination. Joint mobility, cold intolerance, and aesthetic satisfaction were also evaluated. Results: All flaps were successfully reconstructed within 24 h of trauma. Sensory recovery was excellent, with Semmes\u2013Weinstein scores ranging from 1.65 to 2.83, comparable to the uninjured hand. Two-point discrimination averaged 1\u20135 mm in most cases. Cold intolerance persisted in four patients, and mild nail dystrophy was noted in three cases, with one case of nail absence. Aesthetic satisfaction was high in 19 patients. Conclusions: The adipofascial flap effectively restores function and aesthetics in pulp defects, offering superior sensory recovery, high patient satisfaction, and minimal complications. Its regenerative potential and adaptability make it a valuable option for fingertip reconstruction, supporting its continued use in clinical practice.<\/jats:p>","DOI":"10.3390\/jcm14051466","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:22:31Z","timestamp":1740140551000},"page":"1466","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Adipofascial Flap Reconstruction for Pulp Defects: A Retrospective Study of Functional and Aesthetic Outcomes"],"prefix":"10.3390","volume":"14","author":[{"given":"Gabriele","family":"Delia","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University Hospital of Messina \u201cAOU Gaetano Martino\u201d, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University Hospital of Messina \u201cAOU Gaetano Martino\u201d, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Cigna","sequence":"additional","affiliation":[{"name":"Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56122 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Maruccia","sequence":"additional","affiliation":[{"name":"Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1600-7306","authenticated-orcid":false,"given":"Francesco","family":"Stagno d\u2019Alcontres","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University Hospital of Messina \u201cAOU Gaetano Martino\u201d, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/0007-1226(91)90119-5","article-title":"The adipofascial turn-over flap for complicated dorsal skin defects of the hand and finger","volume":"44","author":"Lai","year":"1991","journal-title":"Br. J. Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00000637-200101000-00003","article-title":"Innervated dorsal adipofascial turnover flap for fingertip amputations","volume":"46","author":"Baran","year":"2001","journal-title":"Ann. Plast. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jpra.2018.07.004","article-title":"Is the adipofascial flap the key to regenerative surgery?","volume":"18","author":"Delia","year":"2018","journal-title":"JPRAS Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1177\/1753193409360955","article-title":"Homodigital dorsal adipofascial reverse flap: Anatomical study of distal perforators and key points for safe dissection","volume":"35","author":"Delia","year":"2010","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1302\/0301-620X.85B1.0850152","article-title":"Lister\u2019s \u2018the hand\u2019: Diagnosis and indications","volume":"85","author":"Barton","year":"2003","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.jhsa.2008.02.022","article-title":"Relationship Between Sensory Recovery and Advancement Distance of Oblique Triangular Flap for Fingertip Reconstruction","volume":"33","author":"Sano","year":"2008","journal-title":"J. Hand Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/0007-1226(88)90035-5","article-title":"Step-advancement island flap for fingertip reconstruction","volume":"41","author":"Evans","year":"1988","journal-title":"Br. J. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1097\/01.PRS.0000117298.52225.43","article-title":"The reverse digital artery island flap: An update","volume":"113","author":"Han","year":"2004","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1016\/j.jhsa.2006.06.015","article-title":"Homodigital Antegrade-Flow Neurovascular Pedicle Flaps for Sensate Reconstruction of Fingertip Amputation Injuries","volume":"31","author":"Henry","year":"2006","journal-title":"J. Hand Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3944\/AOTT.2011.2429","article-title":"The outcome of direct-flow neurovascular island flaps in pulp defects","volume":"45","author":"Kayalar","year":"2011","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.jhsa.2005.05.012","article-title":"Innervated reverse island flap based on the end dorsal branch of the digital artery: Surgical technique","volume":"30","author":"Li","year":"2005","journal-title":"J. Hand Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/S0007-1226(68)80033-5","article-title":"Neurovascular island pedicle flaps for terminal amputations and digital scars","volume":"21","year":"1968","journal-title":"Br. J. Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/00000637-198906000-00005","article-title":"The reverse digital artery flap for fingertip reconstruction","volume":"22","author":"Lai","year":"1989","journal-title":"Ann. Plast. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/0266-7681(94)90149-X","article-title":"A homodigital reverse pedicle island flap in soft tissue reconstruction of the finger and the thumb","volume":"19","author":"Niranjan","year":"1994","journal-title":"J. Hand Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/micr.1920080311","article-title":"Neurovascular island skin flaps in the hand: Functional and sensibility evaluations","volume":"8","author":"Stice","year":"1987","journal-title":"Microsurgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jhsa.2006.02.029","article-title":"Innervated Reverse Dorsal Digital Island Flap for Fingertip Reconstruction","volume":"31","author":"Takeishi","year":"2006","journal-title":"J. Hand Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1097\/01.prs.0000234610.81672.e7","article-title":"Structural fat grafting: More than a permanent filler","volume":"118","author":"Coleman","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"xiii","DOI":"10.1016\/j.cps.2015.05.001","article-title":"Fat Grafting: Current Concept, Clinical Application, and Regenerative Potential, Part 2","volume":"42","author":"Pu","year":"2015","journal-title":"Clin. Plast. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0749-0712(21)01396-2","article-title":"The cross-finger flap. An established reconstructive procedure","volume":"1","author":"Kappel","year":"1985","journal-title":"Hand Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00006534-195004000-00011","article-title":"The repair of surface defects of fingers by trans-digital flaps","volume":"5","author":"Gurdin","year":"1950","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.bjps.2005.04.047","article-title":"Donor site morbidity in cross-finger flaps","volume":"58","author":"Koch","year":"2005","journal-title":"Br. J. Plast. 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