Forked finger fillet flap for segmental extensor tendon coverage of an adjacent digit

Finger fillet flaps have been used to treat a variety of complex hand deformities providing stable soft tissue coverage and preventing pathologic contractures. Fillet flaps have not been reported in the coverage of segmental extensor tendon deficit in an adjacent digit. A 20-year-old man involved in a motor vehicle crash sustaining a 30% total body surface area burn, primarily to left arm and bilateral lower extremities. In particular, his left index finger extensor mechanism was disrupted with exposure of the proximal interphalangeal (PIP) joint. In addition, the middle finger had a segmental exposure of the extensor tendon. The nonfunctional index finger was sacrificed to provide coverage, via a forked fillet finger flap, of the exposed extensor tendon at the PIP and metacarpophalangeal (MCP) joints. Total active motion of left fingers at 12 months consisted of the third digit 0 to 86 degrees at the MCP joint, 0 to 88 degrees at the PIP joint and 0 to 33 degrees at the distal interphalangeal joint. Gross grip strength improved to 26 lb at 1 year follow-up. Adequate soft tissue coverage of extensor tendons can be challenging in the traumatic hand. With this novel approach of a forked finger fillet flap we were able to provide adequate soft tissue coverage of exposed tendons and joints improving the patient's strength and active range of motion especially in the middle finger. Prevention of postburn boutonnière deformity was an additional benefit.