The cross-digital dorsal adipofascial flap

The "homodigital distally based" dorsal adipofascial flap has been used by various authors to cover small, complex, dorsal, digital defects. In 2004, Al-Qattan reported on 3 cases in which a "distally based" dorsal adipofascial flap was used in a "cross-digital" fashion. In the current report, we expand on the concept of cross-digital adipofascial flaps in which the flaps are based not only distally but also proximally or laterally located. A total of 14 patients with complex dorsal digital defects were reconstructed with cross-digital adipofascial flaps. The main indication for using the cross-digital technique was a concurrent dorsal skin shear injury adjacent to the complex defect, which precluded the use of the homodigital technique. There were 11 males and 3 females, with a mean age of 27 years. All defects were located on the distal 2 phalanges of the digits. The adipofascial flap was based distally in 2 patients, laterally in 2 patients, and proximally in the remaining 10 patients. Six patients had associated extensor tendon injury. The cross-digital flap was covered with a split skin graft at the time of transfer, and its pedicle was divided 3 weeks later under local anesthesia. The mean follow-up time was 6 months. All flap survived, with no dehiscence or infection. One flap required regrafting at the time of flap division. The mean total range of motion of the involved distal joint of the digit varied according to associated extensor tendon injury from 60 degrees in patients with no concurrent tendon injury to 20 degrees in patients with segmental tendon loss requiring tendon grafts. Patients who had concurrent nailbed injury developed nail plate deformities such as thinning and ridging. One patient had nonadherence of the nail plate. All other patients were happy with the esthetic appearance of the hand following reconstruction.