Optimization of the homodigital antegrade island flap for fingertip reconstruction: New dissection sequence based on cadaver study findings

Abstract

IntroductionThe homodigital antegrade island flap pedicled on the proper palmar digital artery is very useful for covering fingertip defects. However, it has its drawbacks, such as the risk of stiffness due to retractile scars and the need for extensive dissection with long-lasting dysesthesia in some cases. In clinical studies, expanding the skin paddle with V-shaped incisions increases the flap's advancement. We wanted to know whether making these V incisions for paddle expansion would make dissection on the volar side of the proximal interphalangeal joint unnecessary. MethodsA cadaver study was performed with four fresh-frozen upper limbs. Sequential dissection was carried out on 32 flaps, allowing us to compare the advancement obtained and the area of the flap's paddle between each step. ResultsCrossing the palmar crease of the proximal interphalangeal joint provides only 2mm advancement of the homodigital antegrade flap. Adding one or two V-shaped incisions in the flap with limited dissection provides additional advancement of 4.1mm (p<0.05) and 6.9mm (p<0.05) relative to the standard flap. DiscussionOur study shows the possibility of increasing the homodigital antegrade flap's advancement – without having to extend the dissection proximally to the PIP joint – by making V-shaped incisions in the paddle. Based on our findings, we have proposed a new flap dissection sequence.