A Pedicle Flap Based on the Middle Dorsal Branch of the Proper Digital Artery for Tissue Defects in Fingertip

Abstract

Objectives: We report our experience in using a perforator island flap based on the middle dorsal branch of the proper palmar digital artery for repairing fingertip defect and analyze the clinical outcomes in 25 patients. Methods: Between January 2014 and July 2015, we repaired soft tissue defects of 25 fingers, including 10 index, 4 middle, 5 ring, and 6 little fingers, using this pedicle perforator flap. The middle dorsal branch of the proper palmar digital artery was dissected out and was used as the pedicle with fascia tissue of about 5 mm preserved surrounding the pedicle to ensure venous return. The donor located on the dorsal aspect of the proximal phalanx. The defects in the fingertip were pulp defects on the volar or lateral sides, mostly involving the bone or with bone exposure. Donor site was covered with full-thickness skin graft. The flap survival rate and hand function recovery were analyzed. Results: All flaps survived completely. The patients were followed up for 6 to 18 months. The blood circulation, thickness, skin texture, and the color of the transferred flap match those of normal fingertip. The static 2-point discrimination of the flap ranged from 8 to 11 mm. Minor or mild extension contracture of the distal interphalangeal (DIP) joint was noted in most cases, but no severe scar contracture of the DIP and proximal interphalangeal (PIP) joints. Conclusions: We found that the perforator island flap based on the middle dorsal branch of the proper palmar digital artery is an additional good option of distal finger soft tissue repair. The merit of this flap is no sacrifice of the proper digital artery and close proximity of the donor to the fingertip. The vascular supplies to this flap are reliable for a pedicle perforator flap transfer based on our experience.