[Digital flap autografts for pulp coverage in distal amputations of the fingers. 68 flaps]

Sixty-one patients underwent 68 digital pulp amputations involving the distal phalanx (Zone 2 and 3). 46 unipedicular Vankataswami-Subramanian island flaps (VS flap) and 22 bipedicular Moberg-O'Brien flaps (MOB flap) were performed. All distal thumb amputations were treated by MOB flap, whereas all lateral finger distal amputations of the long digits were treated by VS flap. Both flaps were used for the other types of amputation. Four digits developed complications and needed a delayed regularisation. The mean follow-up for the 46 flaps was two years. Pulp reconstruction was satisfactory in all flaps. Sensation was normal or slightly decreased in 66%. Nail dystrophy was considered to be poor in 56% and was attributed to initial trauma and the distal phalanx shortening. 20 degrees of extension deficit was found in 8 patients. We obtained 61 excellent and good results justifying our indications: MOB flap for all types of distal amputation of thumb in zone 2 and 3, VS flap for lateral distal amputations of the long fingers. In transverse amputation of the long fingers, MOB flaps seem to give better results than VS flaps.