De-epithelialized dorsal digital turnover flap for coverage of volar digital lesions: a modified technique

Abstract

Volar digital injuries represent a challenge to hand surgeons. Anatomical studies demonstrate the existence of dorsal digital branches of the ulnar and radial arteries at predictable and regular distances from the PIP joint, bilaterally. Moreover, as there are also small veins that accompany the arterial branches, we designed a novel de-epithelialized dorsal finger turnover flap, which can be performed on the ulnar and radial sides of fingers where it is important to maintain the paratenon to support the dorsal skin flap. A 21-year-old female presented with traumatic injury to the middle phalanx of the third finger associated with loss of substance and damage to the flexor tendons in zone II. The dorsal part of the finger was used to provide coverage for a volar injury. There was no scar retraction or functional limitation of the reconstructed finger. This novel, de-epithelialized dorsal finger turnover flap can be safely used for coverage of volar finger lesions, due to a reliable and well-described arterial supply, with no skin necrosis of the donor site, post-surgical infection, or scarring complications. Level of Evidence: Level V, therapeutic study.