Repair of multiple finger defects using the dorsal homodigital island flaps

Providing soft-tissue coverage for multiple finger defects remains a challenge for the hand surgeons. This article reports reconstruction of multiple digital defects using the dorsal homodigital island flaps based on the dorsal branch of the digital artery.

Over 3 years, a retrospective study was conducted with 12 patients who had multiple finger defects treated with the dorsal homodigital island flaps. Our series included nine male and three female patients. There were 30 soft-tissue defects in 30 fingers. The injured fingers included seven index, nine long, nine ring and five little fingers. The average size of soft-tissue defects and flaps was 2.4 ± 0.4 cm × 1.7 ± 0.2 cm and 2.6 ± 0.4 cm × 1.9 ± 0.2 cm, and the mean pedicle length was 1.1 ± 0.2 cm.

Full flap survival was achieved in 26 fingers. Partial distal flap necrosis was noted in four fingers, which healed without surgical intervention. At a median of 20 (range, 19-23) months' follow-up, the static two-point discrimination on the flap averaged 9.1 ± 1.6 mm, and the median (range) Semmes-Weinstein monofilament score was 3.84 (3.84-4.17). The donor-site morbidity was accepted. According to the Michigan Hand Outcomes Questionnaire, seven patients were strongly satisfied and five were satisfied with functional recovery of the reconstructed fingers.

The dorsal homodigital island flap, based on the dorsal branch of the digital artery, is less invasive, versatile and technically easy for simultaneous coverage of small-to-moderate defects in multiple fingers.