Flap

Tissue

Skin and adipofascial subcutaneous tissue

Course of the vessels

On the undersurface of the flap

Dimensions

2 × 1.5 cm

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Midlateral aspect of the digits; Doppler identification of the artery and its course; usually harvested from the proximal phalanx

Flap design

Flap should be centered over the course of the proper digital artery

Patient position

Arm on arm table with tourniquet; forearm mobile so that the hand can be rotated

Dissection

Perform a digital Allen test if there is suspicion of disturbed circulation in the digit; dissection always starts away from the designed flap (“Go there where the flap is not!”), and this may be proximal or distal from the flap; identify the proper digital artery and nerve, and isolate and arm the nerve with a vessel loop; do not use a hemostat to secure the vessel loop, because a vascular clip is perfect for this purpose; include all tissue that contains the areolar network around the artery into the flap pedicle so that venous outflow is secured, the nerve is spared, and the flap is centered over the pedicle; dissect the pedicle in a way that provides a sufficiently wide arc of rotation; release the tourniquet after a vascular clamp is placed on the artery proximal to the flap; divide the artery when the flap is well perfused through reverse flow and shows no signs of venous congestion, then rotate the flap into the defect; reconstruct the donor site with a full-thickness graft from the hypothenar eminence

Disadvantages

The proper digital nerve can be irritated for a few weeks, but this usually resolves completely