Flap

Tissue

Adipofascial subcutaneous tissue

Course of the vessels

Fragile subdermal vascular network

Dimensions

1.5 × 1.5 cm

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Dorsal aspect of the digits; Doppler identification of the vessels and their courses

Flap design

Mark the defect size on the dorsum of the finger

Patient position

Arm on arm table, with the hand pronated

Dissection

Use an “open the book, close the book” technique: raise the skin flap and preserve the subdermal plexus; arm the skin flap with two stay sutures, and then raise the adipofascial areolar tissue from the paratenon of the extensor tendon; fold the flap into the dorsal defect of the adjacent digit; close the donor site by suturing the skin flap back into place; reconstruct the recipient site with a full-thickness graft, preferably from the hypothenar eminence

Disadvantages

Recipient finger and donor finger have to be immobilized together; we prefer to suture through the pulp to allow for conjoint motion after a few days and to prevent the spreading of the fingers, which risks tearing the pedicle; “buddy taping” is frequently not sufficient

Pedicle is divided after 12–14 days; physical therapy can be started after 3–4 days