Flap

Tissue

Skin and subcutaneous tissue

Course of the vessels

Undersurface of the flap; attached to the flap through a fragile septum and perivascular areolar tissue

Dimensions

2 × 1–1.5 cm

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Lateral half of a digit; digital Allen test

Flap design

Mark the defect size; the flap is designed as a large “V” that is centered over the proper digital artery and that extends toward the volar flexor crease of the metacarpophalangeal joint

Patient position

Arm on arm table, with the hand pronated

Dissection

Incise the flap circumferentially in the marked and required dimensions; dissection starts by identifying the neurovascular bundle proximal to tip of the designed flap; the nerve is identified, isolated, and separated from the artery in its entire length; all areolar tissue around the artery, which provides the venous outflow, should be preserved; after complete dissection of the flap, it is mobile enough to be advanced into the defect; closure is performed in a V-Y fashion; if the defect is not too big, the complete neurovascular bundle can be included in the pedicle flap to provide immediate sensibility

Disadvantages

Some cold intolerance has been reported, but this can also be due to the primary injury