[The cross-finger flap].

OBJECTIVE

Soft-tissue coverage by tissue transposition from a neighboring finger of a palmar (classic cross-finger flap) or dorsal (reversed cross-finger flap) soft-tissue defect of the phalanges.

INDICATIONS: Conventional cross-finger flap: soft-tissue defects in the proximal or middle phalanges not suitable for skin transplantation. Reversed cross-finger flap: soft-tissue defects in the dorsal proximal or middle phalanges not suitable for skin transplantation.

CONTRAINDICATIONS: Extensive tissue defects crossing the finger joints. Concomitant injuries of the neighboring fingers.

SURGICAL TECHNIQUE: Harvesting of an adipocutaneous flap from the dorsum of the finger to the midlateral line, preserving the paratenon of the donor phalanx. Transfer of the flap into the defect of the neighboring finger and coverage of the donor site by full-thickness skin grafting. For the reversed cross-finger flap preparation of a subcutaneous flap with preservation of the peritenon by separating a skin flap from the subcutaneous fat according to the "open book - closed book" technique. Transection of the flap pedicle after 14-21 days.

POSTOPERATIVE MANAGEMENT: Immobilization of both fingers until the pedicle is transected. Active and passive physiotherapy exercises after 5-7 days.

RESULTS

Uneventful healing in all 18 cross-finger flaps, resulting in an average DASH Score (Disability of the Arm, Shoulder and Hand) of 18 after an average follow-up of 38 months (12-81 months). Twelve results were subjectively judged as "very good" or "good", 16 patients complained about intermittent cold intolerance.