A Novel Classification of the Modified Cross-finger Flap for the Repair of Fingertip Defects

The cross-finger flap (CFF) is a standard procedure for fingertip repair. However, the choice of a specific flap design is not standardized and often depends on surgeon experience.

This single-center, retrospective study included 61 patients (average age: 34.1 ± 9.5 y) who had CFF surgery for fingertip defects. We developed 2 related classification systems. The first system classifies the fingertip defect by its main location (types V, U, R, T, and D). The second, the Jun-Yang classification, classifies the CFF itself based on the donor finger side and the pedicle location (types Ia, Ib, IIa, and IIb). We then analyzed the connection between the defect type and the chosen flap subtype. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

A strong association between defect location and flap design was identified. Defects on the volar, lateral, or terminal aspects (types V [volar-central], U [ulnar-oblique], R [radial-oblique], and T [transverse-terminal]; n = 49) were predominantly reconstructed with a subtype "b" flap (98.0%). In contrast, all dorsal defects (type D; n = 12) were reconstructed with a subtype "a" flap. The mean static 2-point discrimination was 7.1 ± 1.3 mm, consistent with established literature.

The Jun-Yang classification codifies a successful, experience-based surgical strategy for CFF subtype selection based on defect anatomy. This framework may serve as a useful decision-support tool to standardize surgical planning and enhance surgical training. Further prospective validation and formal reliability testing are required.