Cross-Finger Flap

Chapter 29

Cross-Finger Flap

Table 29.1 Cross-finger flap




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

Course of the vessels

Axially in the subcutaneous tissue (no identifiable named vessel)


2.5 × 2 cm for both conventional and reverse flaps

Extensions and combinations



Neurovascular pedicle

No defined pedicle



Length and arc of rotation



Surgical technique


Preoperative examination and markings

Preferred donor site: middle phalanx

Flap design

Patient position

Arm on arm table to avoid tourniquet-induced ischemia


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




Simple and reliable

Flap size and shape

Sufficient for most typical defects over the flexor and extensor tendons


Refinement in design with axial vessel included (C-ring flap)



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



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

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