76.1 Description

Several local tissue flaps are available for coverage of the proximal phalanx. The axial flag flap is a simple cutaneous rotational flap from the dorsum of the proximal phalanx rotated to cover the volar or dorsal aspect of the proximal phalanx or metacarpophalangeal joint. The kite flap is a similar fasciocutaneous flap harvested from the radial aspect of the proximal phalanx and can be used to cover adjacent digits or thumb.

76.2 Key Principles

Both flaps utilize the dorsal metacarpal artery of the donor digit. They do not require vascular pedicle dissection; we recommend leaving approximately 5 to 10mm of fatty tissue around the artery. The axial flag flap only needs an intact tissue bridge at the corner about which the flap will be rotated. The small size of the tissue bridge allows for significant mobility of this flap. The kite flap may be mobilized along the length of the artery, usually 30mm.

76.3 Expectations

These flaps reliably provide adequate coverage for the traumatized proximal phalanx with minimal donor-site morbidity. This technique requires a Doppler, basic microsurgical principles, and healthy tissue at the recipient site.

76.4 Indications

Volar or dorsal soft tissue loss of the proximal phalanx or the metacarpophalangeal (MCP) joint requiring coverage. The flap must have a Doppler signal along the dorsal metacarpal artery to allow adequate perfusion of the flap. The recipient site must be a healthy bed with all devitalized tissue removed (► Fig. 76.1).

76.5 Contraindications

• 
  

  Active infection.

  
  
• 
  

  Defect too large for coverage with local flap.

  
  
• 
  

  No Doppler signal of dorsal metacarpal artery.

  
  
• 
  

  History of trauma to the dorsal radial artery, vaso-occlusive or spastic disorder affecting the radial artery.

76.6 Special Considerations

A preoperative discussion with the patient regarding the options for coverage is important to inform as well as manage the expectations of the patient prior to undergoing flap coverage. The patient should be aware that the donor site must be grafted following the mobilization of the flap. Loupe magnification and a Doppler are required for this procedure.