Re-establishing functionality and aesthetics after severe burns over the proximal interphalangeal joint using the cross-digital dorsal adipofascial flap

Abstract

A 34-year-old office worker presented to our unit after sustaining a full-thickness thermal burn to the dorsal aspect of his right index finger. Examination revealed insensate, charred and mildly oedematous skin over the dorsal digit, concentrated over the proximal interphalangeal joint (Fig. 1). Ranges of flexion and extension over both interphalangeal joints were moderately limited. Upon debridement of the non-viable tissue under local anaesthesia, it was discovered that the paratenon of the extensor tendon sheath was significantly burnt. This precluded skin grafting directly over the soft tissue defect, if mobility of the unscathed extensor tendons was to be preserved. To fashion a structure beneath which the tendon could glide freely, the cross-finger adipofascial technique was employed. A donor site was marked on the adjacent middle finger, lateral to the injury. The donor skin was elevated laterally away from the defect, just superficial to the dorsal veins (Fig. 2). An adipofascial flap (comprising some fat, dorsal veins and fascia) was raised from the donor digit (Fig. 3) and sutured to the open defect with absorbable sutures, after the donor skin was sutured back into place. The flap was then covered with a thin unmeshed split-thickness skin graft (Fig. 4). The site was dressed, and the donor and recipient