Graft reposition flap for fingertip injuries

Abstract

We report our technique, graft reposition flap for fingertip injuries with bone and nailbed loss. We reconstructed Allen's IV fingertip amputations in 25 patients between 2015 and 2019. The graft reposition flap technique involves reattaching the amputated stump (distal phalanx, free nailbed graft) with Kirschner wire. In addition, we reconstructed the volar defect with cross finger flap, thenar flaps, first dorsal metacarpal artery-based flap, volar V–Y advancement flap, and antegrade homodigital flaps. The mean follow-up was 25 months. (Range, 12–36 months). We classified the results based on nail aesthetics, finger length, pulp pad, bone consolidation, cosmesis, sensation, pain, range of motion, grip strength, and return to work. Excellent or good results were achieved in 20 cases. Three cases had fair results, and 1 had poor results. We observed partial flap necrosis (n = 1), exposure of distal phalanx (n = 1), hook nail (n = 1) and absent nail (n = 1) This method is simple, reliable, and effective for restoring Allen's type IV fingertip amputation. This technique can be performed efficiently by surgeons in rural and urban hospitals lacking microsurgical expertise. It is an excellent alternative option for replantation. • Graft reposition is reattaching the amputated distal phalanx, nailbed graft. • Reconstructing the volar defect with a pedicled flap. • It is simple, and reliable method for Allen type IV amputations. • It restores the finger function and appearance. • It also restores finger length and sensation.