Alternative hand flaps for amputations and digital defects

Traumatic or thermal injury to the hand may result in a composite tissue loss. Exposed tendon, bone, or joint surface is best treated by flap coverage. This paper will discuss four types of alternative hand flaps that can be used to treat difficult areas and/or minimize complications. (1) A thumb flap elevated from the metacarpophalangeal joint flexion crease covers a fingertip injury and the donor site is closed primarily. (2) A proximally based side-finger flap, preferably from the ulnar side of the donor finger, can be used to cover a fingertip defect in a young person or a thumb tip in any age. (3) A deepithelized cross-finger flap, flipped 180 degrees upside-down, can cover a defect on an adjacent finger. The under side of the flap and the donor area are skin grafted. (4) A proximally based arterialized side-finger flap, including the digital artery but sparing the digital nerve, is rotated dorsally to cover a secondarily exposed proximal interphalangeal joint in burn patients where adjacent fingers are not available as donor sites.