Reverse midpalmar island flap transfer for fingertip reconstruction

Area of Science:

• Plastic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Fingertip injuries with exposed tendon or bone pose significant reconstructive challenges.
• Limited options exist when local or regional artery island flaps are unavailable for fingertip defects.

Purpose of the Study:

• To evaluate the efficacy of vascularized midpalmar flaps for fingertip soft tissue reconstruction.
• To assess the outcomes of using retrograde-transferred midpalmar flaps for palmar skin defects and amputations.

Main Methods:

• Fifteen patients with fingertip injuries underwent reconstruction using vascularized flaps from the midpalmar area.
• Flaps (2.5x1.5 to 4.5x2 cm) were pedicled on superficial palmar arch or digital artery branches and transferred retrogradely.
• Sensory flap transfer was performed in some patients to assess tactile sensation.

Main Results:

• All 15 transferred flaps survived without any complications.
• Mean two-point discrimination in sensory flaps averaged 6 mm, indicating preserved sensation.
• The procedure effectively covered skin and soft tissue defects of the finger.

Conclusions:

• Vascularized skin flaps from the radial or distal midpalm are a successful alternative for fingertip reconstruction.
• This technique provides a reliable option for defects not amenable to other flap methods.
• Midpalmar flaps offer a valuable solution for challenging fingertip soft tissue and palmar skin defects.