Reverse neurovascular homodigital island flap.

We describe a homodigital island flap with a reverse vascular pedicle based on the anastomoses between the radial and ulnar digital arteries. These anastomotic branches lie between the posterior wall of the tendon sheath and the periosteum to form the three digitopalmar arches. The vascularization of the reverse homodigital island flap is obtained using the middle transverse palmar arch. This flap was performed in 11 patients as a neurovascular "sensitive" flap, including the digital nerve in the pedicle, which was then sutured to the contralateral one at the defect. This technique achieves cover of the tactile pad in one operative stage and provides well-vascularized skin, allowing early mobilization. The quality of skin cover was confirmed in all the patients at follow-up ranging from 7 to 43 months postoperatively. We believe that the benefits of the procedure outweigh the disadvantages related to the section of the digital nerve and artery.