Flap

Tissue

Skin and adipofascial subcutaneous tissue

Course of the vessels

On the undersurface of the flap

Dimensions

2 × 1.5 cm

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Midlateral aspect of the digits; Doppler identification of the artery and its course

Flap design

Flap should be centered over the course of the proper digital artery; usually harvested from the middle phalanx

Patient position

Arm on arm table with tourniquet; forearm mobile so that hand can be rotated

Dissection

Starts away from the designed flap, either proximal or distal from the flap (“Go there—where the flap is not!”); identify the proper digital artery and nerve; nerve is isolated and armed with a vessel loop; use a vascular clip (not a hemostat) to secure the vessel loop; include all tissue that contains the areolar network around the artery in the flap pedicle so that venous outflow is secured, the nerve is spared, and the flap is centered over the pedicle; the pedicle is dissected in a way that provides a sufficiently wide arc of rotation; the tourniquet is released after a vascular clamp has been placed on the artery distal to the flap; the artery is divided when the flap is well perfused and does not show signs of venous congestion; the flap is rotated into the defect; the donor site can be reconstructed with a full-thickness graft from the hypothenar eminence

Disadvantages

Proper digital nerve can show some irritation for a few weeks but this usually resolves completely