Reverse dorsolateral proximal phalangeal island flap: a new versatile technique for coverage of finger defects

All flaps described for the reconstruction of finger defects have limited indications and many disadvantages. In this study, I successfully developed a reverse digital artery flap raised from the overall side and dorsal aspects of the proximal phalanx, excluding the digital nerve, for closure of fingertip and middle phalangeal defects, and called this the 'reverse dorsolateral proximal phalangeal island flap'. The donor site defect was covered by another flap called the 'dorsal metacarpal V-Y island flap'. The method was used for 12 complicated phalangeal defects in 11 patients. Flap sizes ranged from 2 x 1.5 cm to 3 x 2.5cm. The flap was applied with versatile designs including distal interphalangeal (DIP) (9) or proximal interphalangeal (PIP) anastomoses-based flaps (3); homodigital (10) or heterodigital flaps (2) from the injuries or adjacent finger, respectively; multiple flaps from the two distinct fingers in the same hand (1); and a sensate flap (1). The average follow-up time was 11.5 months. All reverse flaps and V-Y donor site flaps survived completely. Finger lengths and motions were satisfactory with favourable aesthetic results in all cases. The mean value of static two-point discrimination was 9.3mm. I strongly advocate this new flap, as a single versatile flap, for repair of different-sized or complex phalangeal defects. By means of this 'dual-flap manoeuvre', any defect distal to the PIP joint in various dimensions can safely be covered without using a skin graft in the donor area. I also suggest the dorsal metacarpal V-Y island flap alone for dorsal phalangeal defects proximal to this point.