Fingertip Reconstruction With Reverse Adipofascial Homodigital Flap

Due to the importance of hand functions, fingertip injuries should be reconstructed by flap coverage. Although reverse homodigital island flap is an option that is widely used, the classical homodigital flap, which includes a skin graft for the donor site, leads to many donor-site problems such as maceration, and primary or secondary contraction. Reverse homodigital adipofascial flap (RHAF) has been chosen to prevent donor-site complications. To emphasize the efficacy of this flap, we report the outcome of 14 RHAFs, which were used for fingertip reconstruction following traumatic amputations.

From May 2010 to June 2012, 14 fingertip amputations were reconstructed with reverse adipofascial homodigital flap. Six months following surgery, the patients were evaluated with examination using 2-point discrimination, measurement of the range of motion of the proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP), pain [evaluated with the Visual Analogue Scale (VAS)], and the time to return to their previous activities.

All flaps survived completely. Donor sites healed without any complication. Two-point discrimination was a mean of 4.86 ± 0.95 mm. The range of motion of the PIP and DIP joints was similar to that of the contralateral finger. The VAS score was a mean of 0.9 (range 0-2). All patients returned to their previous occupations within 30 to 60 days (average 40 days). The operation did not impair functional and other activities.

Reverse adipofascial homodigital flaps maintain the perpetuation of digital length, volume of pulp, and service of finger function. The donor site on the lateral surface of the proximal phalanx can be primarily closed. For traumatic fingertip amputation, this flap delivers consistent aesthetic and functional results.