[The dorsal flag flap for skin coverage of finger and thumb-tip injuries].

OBJECTIVE

Immediate two-step coverage of dorsal finger and thumb-tip soft-tissue defects with a dorsal flag flap, which can bridge over two fingers if necessary.

INDICATIONS: Soft-tissue defects on the dorsal aspect of fingers between the metacarpophalangeal and the distal interphalangeal joint as well as on the tip of the thumb.

CONTRAINDICATIONS: Large defects, complex hand trauma, need of a sensible thumb tip, infections, noncompliance.

SURGICAL TECHNIQUE: Marking of the flap at the middle phalanx and its flagpole pedicle, containing the dorsal digital artery. The breadth should reach to the middle of the finger and the proximal pole should not cross the middle of the proximal phalanx. With tourniquet dissection of the flap above the peritendineum with respect of the dorsal digital artery and subcutaneous veins in the pedicle. Opening of the tourniquet, in the case of flap perfusion transposition of the flap into the defect. Coverage of the donor site with skin graft.

POSTOPERATIVE MANAGEMENT: Palmar cast splinting in intrinsic-plus position for 1 week, followed by physiotherapy. Pedicle separation after 3 weeks. Continuation of physiotherapy and scar care.

RESULTS

In 2006, ten patients were operated on, three of them for reconstruction of the thumb tip. All patients showed a survival of the flap and a good wound healing without complications. One patient developed a flexion contracture at the donor finger due to noncompliance following immobilization. The functional and aesthetic results were satisfactory in all patients, the average DASH Score ("Disabilities of the Arm, Shoulder and Hand") was 16.4, mainly due to the residuals of the overall injury.