Antegrade homodigital island flap: Tips and tricks

Abstract

Background: The aim of fingertip reconstruction is to provide stable sensate coverage and maintain the finger length. Homodigital island flaps may be elevated based on an antegrade or retrograde design. In this study, tips and tricks for the antegrade flap are elaborated to highlight its use in fingertip reconstruction. Patients and methods: Between February 2016 and March 2018, 30 patients (37 fingers) were treated with antegrade homodigital island flaps. Most of the defects were post-traumatic; however, post-burn, contracture release, and diabetic defects were included. Many tips for the surgical technique were discussed. Results: Thirty-six flaps survived, and flap loss occurred in one diabetic finger followed by finger amputation. Patient satisfaction was assessed regarding the function and cosmetic outcome. Complications included flap necrosis in one patient, post-operative proximal interphalangeal joint (PIP) flexion contracture (< 20°) in 4 patients, and suture disruption that required dressing and were healed by secondary intention in 6 patients. Conclusion: The antegrade homodigital island flap is considered a good alternative for fingertip coverage, providing a stable, durable cover. Moreover, the shape and contour of the tip improves with time. The surgical tips provided in this work will help surgeons inside the selection, choosing whether to include the nerve and managing the donor site.