Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery

A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. Light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects.