Assessing Donor Finger Morbidity in Cross-Finger Flap Surgery: A Comprehensive Longitudinal Study

Background: The cross-finger flap is a reliable technique for soft tissue reconstruction in finger injuries, providing pliable tissue and anatomical security. However, donor finger morbidity remains a concern. This retrospective cohort study evaluated donor-site outcomes, focussing on functional recovery and patient-reported measures. Methods: This retrospective cohort study included 30 patients who underwent cross-finger flap surgery, predominantly males (80%) aged 21-40 years, mostly manual labourers with workplace-related injuries. The index finger was most injured (48%), while the middle finger served as the primary donor (66.6%). Assessments included donor finger pain, total active motion (TAM), pinch strength, aesthetic outcomes and complications. Statistical analysis compared donor and control fingers to evaluate functional recovery and patient satisfaction. Results: Patient satisfaction was high (96.7%), with minimal donor site pain (93%). A significant reduction in TAM was observed in donor fingers compared to controls (p = 0.029). Maximal pinch strength showed no significant difference (p = 0.415). Complications included hyperpigmentation (20%) and partial graft loss (10%) and hypertrophic scar (3%). Conclusion: The cross-finger flap remains an effective reconstructive option with high patient satisfaction. However, donor finger morbidity, particularly reduced TAM, underscores the need for structured postoperative rehabilitation. Early flap division and supervised physiotherapy may optimise functional recovery. Study limitations include sample size, but these findings demonstrate the procedure's viability for soft tissue reconstruction. Level of Evidence: Level IV (Therapeutic).