Reverse midpalmar island flap transfer for fingertip reconstruction

Significant soft tissue defects of the fingertip with exposure of tendon or bone represent a challenging problem when homodigital or heterodigital artery island flaps are not available. In an attempt to resolve this problem, 15 patients with fingertip injuries involving palmar skin defects or amputation were treated with a vascularized flap transfer from the midpalmar area. A 2.5 x 1.5 to 4.5 x 2 cm flap from the radial or distal aspect of the midpalm, pedicled on the terminal branch of the superficial palmar arch or common/proper palmar digital artery and vein, was transferred in a retrograde fashion to cover the skin and soft tissue defects of the finger. All the flaps survived without complications. Moving two-point discrimination in the flap averaged 6 mm in patients who underwent sensory flap transfer. We concluded that vascularized skin flaps from the radial or distal aspects of the midpalm offer a good alternative option for the reconstruction of fingertip palmar skin and soft tissue defects.