Flap

Tissue

Skin (conventional flap) or adipofascial tissue (reverse flap)

Course of the vessels

Axially in the subcutaneous tissue (no identifiable named vessel)

Dimensions

2.5 × 2 cm for both conventional and reverse flaps

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Preferred donor site: middle phalanx

Flap design

—

Patient position

Arm on arm table to avoid tourniquet-induced ischemia

Dissection

Conventional flap: incise at the dorsolateral border of the digit and raise the flap in the plane above the tendon, with preservation of the paratenon; free the laterovolar vessels as far as possible without violating the neurovascular bundle, then suture the flap into the defect; apply a skin graft to the donor site

Reverse flap: incise and raise a thin skin flap, with preservation of the subdermal plexus; raise a flap of adipofascial tissue, with preservation of the paratenon; flip the subcutaneous flap into the defect; cover the donor site with the previously dissected skin flap

Disadvantages

Flap size

Not optimally suited for a longitudinal oval defect over several joints

Donor site morbidity

Skin graft for the conventional flap may be conspicuous during the postoperative period but improves with time