Cross-Finger Flap

Chapter 29


Cross-Finger Flap


Table 29.1 Cross-finger flap






























































































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



Anatomy


 


Neurovascular pedicle


No defined pedicle


Artery



Veins



Length and arc of rotation



Diameter



Nerve



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


Advantages


 


Dissection


Simple and reliable


Flap size and shape


Sufficient for most typical defects over the flexor and extensor tendons


Combinations


Refinement in design with axial vessel included (C-ring 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


Pearls and pitfalls


 


Dissection


Preservation of the paratenon is of utmost importance for skin graft take; preservation of the subdermal plexus guarantees excellent reconstruction of the donor site with a reverse flap


Extensions and combinations



Contouring and correction


Rarely required


Clinical applications


Conventional flap: volar digital defects


Reverse flap: dorsal digital defects


May 9, 2019 | Posted by in Reconstructive surgery | Comments Off on Cross-Finger Flap

Full access? Get Clinical Tree

Get Clinical Tree app for offline access