Long-term functional and aesthetic outcomes of the Joshi and Pho Flap for subtotal digital pulp reconstruction: A retrospective case series of 14 patients - 01/09/26

Doi : 10.1016/j.hansur.2026.102766

Rachel Le Dreau ^a,⁎ , Marine Aubey ^a, Christophe Hulet ^a, Gaëlle Maroteau ^b, Isabelle Auquit-Auckbur ^c

^a Department of Orthopaedics and Traumatology, Caen University Hospital, avenue de la côte de Nacre, 14 000 Caen, France

^b Department of Orthopaedics and Traumatology, unité Inserm Comète 1075, Caen University Hospital, avenue de la côte de Nacre, 14 000 Caen, France

^c Department of Plastic and Hand Surgery, Rouen University Hospital, 3è boulevard Gambetta, 76 000 Rouen, France

^⁎ Corresponding author.

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Tuesday 01 September 2026

Abstract

Purpose

Fingertip injuries are very common and can lead to significant functional impairment or even loss of finger function. Techniques for pulp reconstruction often involve the use of flaps. The Joshi and Pho flap is a single-pedicle island flap. Our purpose was to evaluate the long-term functional and aesthetic outcomes of the Joshi and Pho flap in digital pulp reconstruction from 2010 to 2022 in a University Hospital.

Methods

An observational retrospective single-center study included 14 patients who underwent Joshi and Pho flap reconstruction for subtotal pulp defects between 2010 and 2022, with a minimum follow-up of 12 months. The primary outcome was functional recovery assessed by the DASH score. Secondary outcomes included pain (VAS, DN4), joint mobility, sensibility (two-point discrimination, Semmes-Weinstein monofilament test), scar quality (POSAS scale, donor site morbidity), flap survival and complications.

Results

The mean follow up duration was 78 month (min-max : 12-183). The mean DASH score was 22.16/100 (min-max: 5-45; SD: 11.9). Pain scores were low (VAS: 0.64 SD; DN4: 0.5 SD). DIP flexion was statistically reduced on the injured side (58 ° vs 63 °, p < 0.01), but the clinical relevance of this reduction was limited. Two-point discrimination averaged 5.4 mm and the mean Semmes-Weinstein monofilament test was 3,5 mm with 6 patients (43%) grade 6. POSAS scale were 13.9/60 (patient) and 17.7./50 (observer). No flap necrosis was observed. One infection led to secondary amputation. Donor-site morbidity was minimal with no case of hook deformation ou ungual dystrophy.

Conclusion

The Joshi and Pho flap provides a durable and sensible coverage for subtotal digital pulp defects with satisfactory long-term function and aesthetic outcomes. It remains a valuable reconstructive option in hand surgery.