Reverse Homodigital Flap

Abstract

The objectives in fingertip reconstruction surgery are to preserve functional length and sensibility, prevent neuroma formation and articular stiffness, and minimize aesthetic deformities. The reverse homodigital flap technique, first described by Weeks and Wray in 1973, consists of a single stage procedure that maintains finger length and creates a skin cover similar to the native fingertip, thus avoiding long-term immobilization, maintaining the protective sensibility of the finger, and providing a good aesthetic and functional outcome. The authors attempted to analyze the aesthetic and functional outcomes obtained with the reverse homodigital flap technique for fingertip reconstruction. Twenty-seven patients with 28 distal finger injuries were reconstructed using the reverse homodigital flap in the Hospital del Trabajador de Santiago between January 2001 and December 2003. Clinical records were analyzed for tabulation of data regarding: age, sex, injury mechanism, affected finger, donor-site closure, flap laterality, surgical time, and complications. The follow-up ended in May 2004, when ROM, sensibility, and aesthetic satisfaction were evaluated. In all patients, the flap remained vital and no necrosis was found. There where 5 cases of superficial infection and venous congestion, treated with frequent dressing changes, antibiotics, and i.v. Dextran 40 in the cases of venous congestion. Most patients reached an S3 or S3 + sensibility, according to BMRC. ROM was good or excellent in 90% of the patients (ROM>#x2009;90%); the aesthetic outcome, on a 0–10 scale, obtained an average of 8 points, and was considered good. The authors believe that the use of the reverse homodigital flap for fingertip reconstruction is an excellent solution, as it avoids finger amputation, allows a good fingertip skin coverage, avoids long-term immobilization, conserves the protective sensibility of the finger, and allows a good functional and aesthetic outcome.