In this review, an international group of senior hand surgeons was asked to provide their currently used methods, views, and advice on thumb and fingertip repair. The basic requirements and methods of thumb and fingertip repair are first outlined, followed by descriptions of the methods favored by individual units or surgeons. More recent innovative methods and modifications are described and challenging topics are discussed. This review ends by illustrating and discussing a few exploratory treatments that hold promise of greatly changing future perspectives of this common clinical problem.
Key points
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The pulp defect, or distal thumb or finger amputation, often requires cover with flaps from the same digit, or from other parts of the hand or body.
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Sensate, homodigital flaps pedicled anterogradely on a digital artery are used often for fingertip.
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The Moberg and V-Y advancement flaps are commonly used for distal soft tissue loss with bone exposure. Modification of the Moberg flaps and an extended version of the Segmüller flap help flaps to reach the tip of the digit.
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Reverse homodigital flaps for finger pulp or tip defect are used less frequently than a decade ago.
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Free vascularized toe pulps, wrap-around big toe flaps and partial toe transfers are in common use.
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First-line surgical options and surgeons’ preferences vary globally. Asian surgeons do challenging replantations of the thumb and fingertips. European surgeons do more modifications and innovations of the homodigital flaps. Surgeons use the classical cross-finger flap less and less.
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