Homodigital Flap Research Articles

Fingertip reconstruction with a dorsal island homodigital flap

A distal dorsal island homodigital flap has been used for reconstruction of fingertips in nine patients who sustained traumatic amputations either obliquely or transversely through the middle of the distal phalanx. Seven of the nine patients attended for follow-up. All the flaps survived with the exception of a small area of partial necrosis in one patient. Fingertip reconstruction with this flap is a one-stage procedure, safe, easy to perform and provides durable tissue support for the nail to regrow undeformed.

Homodigital flaps--especially for treatment of the burned hand.

Burn deformities involving the hand can cause a devastating impairment that often requires ingenious solutions to improve function. Fortunately, a skin shortage usually can be expeditiously replaced by autogenous skin grafts; otherwise, a vascularized flap may be imperative. If that is so, use of a donor site from the digit itself would always be preferable, because normal sensation potentially could be maintained with similar thin, extensile, and durable tissue. The sides of the finger often have been protected from the thermal injury and are available for use as homodigital flaps. Although technically this form of homodigital flap is an axial flap because it incorporates dorsal digital artery branches, the proper digital artery is always spared. The immediate transfer of a homodigital flap completes the desired reconstruction in a single stage, which allows early initiation of hand mobilization and rehabilitation.

Reverse Dorsal Digital Island Flap

The anatomic and clinical bases for a reliable and versatile homodigital flap for covering difficult distal dorsal and dorsolateral wounds of the long fingers are presented. This one-step procedure, which uses the dorsal skin of the first or second phalanx transposed as a reverse island flap, preserving the collateral nerve and artery to the fingertip, has proved valuable in salvaging the severely injured digits of nine patients (for a total of 12 flaps). It would seem to be a relatively simple way of achieving early recovery because it does not require distant flap reconstruction, the immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger. Furthermore, it reduces the time of hospitalization and improves patient welfare.

Reverse Dorsal Digital Island Flap

The anatomic and clinical bases for a reliable and versatile homodigital flap for covering difficult distal dorsal and dorsolateral wounds of the long fingers are presented. This one-step procedure, which uses the dorsal skin of the first or second phalanx transposed as a reverse island flap, preserving the collateral nerve and artery to the fingertip, has proved valuable in salvaging the severely injured digits of nine patients (for a total of 12 flaps). It would seem to be a relatively simple way of achieving early recovery because it does not require distant flap reconstruction, the immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger. Furthermore, it reduces the time of hospitalization and improves patient welfare. (Plast. Reconstr. Surg. 93: 552, 1994.)

Dorsal V-Y advancement flaps in digital reconstruction

A series of 29 patients is presented in which 40 dorsal full-thickness defects of the digits were reconstructed using homodigital flaps advanced distally with V-Y closure of the donor defect.

The homodigital subcutaneous flap for cover of dorsal finger defects

The authors propose a volar subcutaneous pedicled flap to cover skin defects over the dorsum of the same finger. This flap includes all the subcutaneous (adipofascial) tissues from the reticular dermis to the synovial sheath of the flexor tendons. After elevation of the dermo-epidermal flap, the subcutaneous tissues are raised as a flap pedicled laterally on one of the collateral arteries which constitutes the axis of rotation and transposition. After release of the collateral neurovascular bundle from its connections with the skeleton, the skin and the synovial sheath, the flap can be transposed to the dorsum of the finger and then covered with a split thickness skin graft. The advantages of this technique are: (1) No functional or cosmetic sequelae at the donor site which is closed by the volar dermo-epidermal flap; (2) Homodigital flap. This is particularly helpful in cases of multidigit involvement where cross-finger flaps cannot be performed; (3) Vascular reliability; (4) Preservation of both collateral arteries.