gms | German Medical Science

Objectives/Interrogation: Local or free digital artery perforator flaps based on a constant distal perforator in the middle phalanx for resurfacing the fingertip defect were frequently reported in previous articles. The donor sites of these flaps all were located on the dorsum or lateral of the middle phalanx, and the flap are not suitable for covering the large area of fingertip defect. Therefore, we reported our experience using a reverse, homodigital flap based on a constant distal perforator in the middle phalanx harvested from the dorsolateral proximal phalangeal area for reconstructing fingertip defects with large area.

Methods: From November of 2017 to April of 2018, 11 fingers with fingertip and pulp defect were treated with this technique. The mean area of flaps was 6 (range 4-8) cm². The flap is designed on the dorsolateral of the proximal phalanx of the injured finger in a teardrop shape. The flap was dissected and elevated superficial to the extensor tenosynovium and the dorsal branch of the digital nerve was identified and divided proximally and included in the flap. 8 mm width of fascial pedicle was dissected and preserved at the distal point of flap. Then the pedicle was elevated in the distal and palmar direction until to the digital artery proximally the middle phalanx neck. The digital artery perforator in this site was not necessary to dissected clearly. Then the homolateral digital neurovascular bundle was dissected proximally from the proximal point of the defect in order to achieve a more free rotation of flap. The flap is then rotated to resurface the fingertip defect. Fingertip sensation is reestablished through coaptation of the proximal end of the dorsal branch of digital nerve to the stump of proper digital nerve.

Results and Conclusions: The color of the most flaps was reddish with capillary reflux slowly in 1 day after operation, and then was gradually reddening. The venous congestion was occurred in 4 flaps, but no treatment was taken. Marginal part necrosis was found and continuous dressing was treated in one of the 4 flaps. There were no other complications. The other flaps survived completely. The average follow-up period was 5 months (range, 4- 7 mo). No further flap debulking was required. The mean range of active motion of the proximal and distal interphalangeal joints of the donor fingers were 93 and 76 degrees, respectively.

We conclude that this technique is a reliable, simple, and reproducible method for reconstruction of soft tissue defects of the fingertip with large area.