Proper Digital Nerve Research Articles

Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects.

The authors presented their clinical experience and demonstrated surgical methods to reconstruct soft-tissue defects in the digit by using modified innervated radial collateral artery perforator flap. Surgical procedures that involved 12 modified innervated radial collateral artery perforator flaps were performed in 12 patients. Among the patients, two had defects in the thumbs, six had defects in the index fingers, whereas two had defects in the middle fingers, two had defects in the little fingers. The flaps ranged in size from 5.0 × 2.0 to 7.5 × 4.0cm. The pedicle of the flap was divided and ligated below the level at which the radial collateral artery was divided into anterior and posterior branches. The recipient vessels were the proper digital artery and the palmar subcutaneous vein (n = 8), the deep branch of the ulnar palm artery (n = 4), and the venae comitantes. Nerve suture was done between the posterior cutaneous nerve of the arm and the proper digital nerve of the digital. The cosmetic appearance of the donor and recipient sites and static two-point discrimination of the operated finger were evaluated in a follow-up visit. Postoperative venous congestion happened in two cases, and both succeeded after exploration. All flaps survived, and all donor sites were closed directly, leaving a linear scar. Follow-up time ranged from 12 to 28months. Defatting of the flap was performed in two cases during the late postoperative period. Cosmetically acceptable results were achieved for the rest of the patients. The modified innervated radial collateral artery perforator flap is a good option for reconstructing soft-tissue defects in digits.

Anatomy of the direct small branches of the proper digital nerve of the fingers: A cadaveric study

The purpose of this study was to evaluate the anatomical constancy of the direct small branches of the proper digital nerve. A total of 208 digital nerves of the index, long, ring, and little fingers from 13 cadavers were studied. For each digital nerve, the number of direct small branches was counted at the proximal and middle phalanx levels. In addition, the diameter of these branches was measured at the level of the branch bifurcation. We also measured the diameter of the proper digital nerve at the level of the distal interphalangeal (DIP) joint. The direct small branches of the proper digital nerve were anatomically constant among the index, long, and ring fingers. The average number of direct small branches was 2.7 at the proximal phalanx level and 2.3 at the middle phalanx level. At the level of the DIP joint, the average thickness of the proper digital nerve was 0.85mm in the index finger, 0.84mm in the long finger, 0.72mm in the ring finger, and 0.49mm in the little finger. In this study, we verified the anatomical constancy of the direct small branches of the proper digital nerve. The size of these branches at the proximal phalanx level was similar to that of the corresponding proper digital nerve at the level of the DIP joint. Therefore, these nerve branches at the proximal phalanx could be applied to the creation of various sensate flaps for the reconstruction of the fingertip injuries.

Use of the Dorsal Digital Sensate Free Flap for Reconstruction of Volar Soft Tissue Defect of Digits

Sensate cross-finger flaps and homodigital and heterodigital island flaps can usually be used for sensory reconstruction in the volar aspect of the digit. However, when the donor areas are damaged by concomitant injuries, these flaps are not available. The free dorsal digital flap, including both dorsal branches of the proper digital nerves, can be used as an alternative to resolve this problem. The flap was used in 16 patients with soft tissue defects on the volar aspect of the digits. For comparison, we collected a consecutive series of 31 patients with similar defects treated using a cross-finger flap including one branch. At final follow-up, the static 2PD of 2-branch flap is superior to 1-branch flap. The dorsal digital sensate free flap can be used as an alternative for the reconstruction of volar soft tissue defect of the digits. Sufficient sensory recovery can be achieved using this technique.

Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

Use of Free Modified Innervated Posterior Interosseous Artery Perforator Flap to Repair Digital Skin and Soft Tissue Defects.

Current techniques to reconstruct soft tissue of the fingers result in scarring and functional deficits. Perforator flaps raised on the posterior interosseous artery are thin and well vascularised, and cause minimal donor site scarring. Using a flap with sensory nerves was hoped to contribute to the desired postoperative sensory recovery of fingers. We used modified innervated posterior interosseous perforator flaps to repair digital defects in 18 patients. Injuries included digit amputations and palmar soft tissue defects. The posterior antebrachial cutaneous nerve was carried in the flap and bridged with the defect section of the proper digital nerve. The flaps used measured 10cm × 6cm to 5cm × 3cm. All 18 flaps survived; one necrotic edge eventually healed. During the 10-28months of follow-up (average, 14months), two-point discrimination in flaps and injured fingers was 6-15mm. Good functional and sensory outcomes were obtained in primary operation, and patients were generally satisfied with the aesthetic results. Further work will be needed to assess the branches of the posterior interosseous artery preoperatively to improve surgical planning.

Arched nerves of double end-to-side neuroanastomosis for repairing bilateral acute proper digital nerve injuries

Objective To explore a new method for repairing bilateral acute proper digital nerve injuries.Methods From Feb.2009to Aug.2012,56patients with bilateral acute proper digital nerve injuries were admitted to our center,with 20 undergoing double end-to-side neuroanastomosis.During operation,the injured digital nerve was excised,and then the bilateral distal ends and proximal ends were stured,consequently forming the distal and proximal nerve bows.A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm,and then was equally divided into 2parts to bridge the 2nerve bows.Twenty patients underwent nerve graft with end-to-end neuroanastomosis,and the rest 16patients underwent direct end-to-end neuroanastomosis.Results All the patients achieved primary healing of wound after operation,with no circulation disorders.A total of 50patients were followed up for 3-12 months.In double end-to-side neuroanastomosis group,18 patients were successfully followed up,with the average sensation measurement being S3+,which was significantly higher than those of the other 2groups(P=0.024).The average result of two point discrimination was(5.2±0.7)mm,which was significantly lower than those of the other 2groups(P=0.037).According to TAM scales,the results of finger joint motionwere excellent in 14cases,good in 3cases and fair in 1;and there were no significant differences in the motion of joints between the 3groups(P=0.914).In nerve graft with end-to-end neuroanastomosis group,19patients were successfully followed up; the average result of sensation measurement was S2and the average result of two point discrimination was(7.2±1.4)mm.In direct end-to-end neuroanastomosis group,13 patients were successfully followed up;the average result of sensation measurement was S3and the average result of two point discrimination was(6.3±0.8)mm.Conclusion The arched nerves of double end-to-side neuroanastomosis can be used for repairing bilateral acute proper digital nerve injuries,which can quickly restore the sensation of fingers,but the related conclusion needs further verification with large sample studies.

Can palmar creases serve as landmarks for the deeper neuro-vascular structures?

Purpose The aim of this study was the examination of the superficial anatomy of palmar creases and their relation to deeper neuro-vascular structures.MethodsFour creases: distal wrist flexion crease, thenar crease, proximal palmar crease and distal palmar crease were evaluated with reference to the following structures: palmar cutaneous branch of median nerve, palmar cutaneous branch of ulnar nerve, the nerve of Henle, transverse palmar branches from ulnar nerve, recurrent motor branch of median nerve, radial proper palmar digital nerve to the index and the ulnar proper palmar digital nerve to the thumb, Berrettini’s communicating branch, ulnar nerve and artery, superficial palmar arch. We performed dissections of 20 cadaveric upper limbs derived from a homogenous Caucasian group. In our study we measured the location of surgically important structures with reference to palmar skin creases.Results Among the other observations we noticed that the palmar cutaneous branches of the median and ulnar nerves were located at least 0.5 cm away from the thenar crease. The superficial palmar arch was found between the thenar and proximal palmar crease and never crossed the proximal or distal palmar creases.ConclusionsThese anatomical dissections will provide reference material for further ultrasound studies on the arrangements of neuro-vascular structures in reference to superficial palmar creases.

Sensibilitätsrückkehr nach kindlichen Nervenverlet­zungen der Hand - welche Rolle spielt das Patientenalter?

The regenerative capacity after nerve reconstruction in children is believed to be superior compared to that in adults. However, the available data on this topic are limited. The aim of this work is to improve the age-dependent assessment of the prognosis after surgical treatment of peripheral nerve injuries of the hand. 44 of 147 children with complete transections of proper and common digital nerves who were treated from 2000 to 2009 and who were currently 6 years or older, could be included for follow-up (mean time, 7.5 years). In total there were 60 nerve injuries, of which 56 were directly coaptated, 4 needed grafting. Sensitivity of the fingertips was assessed using the 2-point discrimination (2PD) test and the Semmes-Weinstein monofilament test. We also recorded hypersensitivity, sensitivity to cold, and paresthesia. To account for inter-individual differences in normal 2PD, the difference of the 2PD to the uninjured contralateral side was calculated as delta-2PD. The age at the time of the injury, divided into groups of 0-5, 6-10 and 11-15 years was correlated with the clinical outcome (2PD, monofilamenttest). Taking into account the results classified by age presented by Lohmeyer et al. and Mailänder et al., we assessed the correlation between age at injury (0-85 years) and clinical outcome. After 52 of the 56 direct nerve coaptations (93%) normal sensitivity was found with a 2PD<6 mm, 4 times the 2PD was 6 mm. Following nerve grafting a static 2PD of 6-7 mm was measured. Disturbing paresthesia, sensitivity to cold or hypersensitivity were not reported by any patient. The 2PD of the fingers of the opposite uninjured side showed great inter-individual differences. Patient's age and 2PD significantly correlated with significantly poorer results already in the second decade of life. In relation to adults, children have an excellent prognosis after nerve reconstruction. The high inter-individual differences in regular sensitivity, depending on age, co-morbi-dities, etc., suggest putting the results of the injured and uninjured sides into relation. Estimation of the Δs2PD may solve this -problem.

Restoration of Thumb Sensibility with Innervated Reverse Homodigital Dorsoradial Flap

This study investigates the use of homodigital reverse dorsoradial flap with neurorrhaphy for thumb soft tissue defect. From 1996 to 2010, the homodigital dorsoradial flap was performed on seven adult patients and one 3-year-old boy. The flaps ranged from 1.2 to approximately 3.0 cm × 2.0 to approximately 4.2 cm in size. In six of the eight patients, the dorsal collateral branch of the radial nerve supplying the flap was also included in the pedicle and coapted to the proper digital nerves of the thumb. At final follow-ups, flap sensation, thumb motion, and donor-site morbidity were assessed. All flaps survived completely. At final follow-up of 8.5 months (range, 3 to 14 months), all patients except the 3-year-old child (who could not express clearly) reported satisfactory sensory recovery, with the static two-point discrimination ranging between 6 and 12 mm (mean, 9.4 mm). Range of motion of the metacarpophalangeal and interphalangeal joints of the thumbs was also preserved with minimal donor-site morbidity in all cases. Innervated reverse homodigital dorsoradial flap serves as a reliable and sensate flap for extensive thumb soft tissue reconstruction.

Digital Neural Loops: Classification and Implications of Variation in Hand Surgery

The "neural loop" describes a digital artery passing through a digital nerve, after which both the structures progress distally to supply the digit. While rare, past descriptions refer to neural loops located around the common palmar digital arteries, with no reports of more distal loops. We describe a case in which a distal neural loop was identified, with the ulnar proper palmar digital nerve (PPDN) to the long finger split, and reconstituted around the radial proper palmar digital artery (PPDA) to the ring finger. This variation was explored within the previously reported classification systems for such neural loops in the literature. Previously reported neural loops have been localized to the palm, without report of formation of a neural loop by the penetration of a PPDA. A new classification of neural loops is presented in this context on the basis of anatomical location. This new model, of separating neural loop position into anatomical levels, provides more information to the hand surgeon when dissecting and raising vascular pedicles for flaps reconstruction.

Distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch to repair fingertip defects

Objective To analyze the clinical outcomes of treating fingertip defects with distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch.Methods Twenty-three cases with soft tissue defects in the pulp or dorsum of the fingertip were treated by the distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch from July 2010 to January 2012.Results All 23 flaps survived completely.Twenty-one cases were follow-up from 3 to 15 months with an average of 6.7 months postoperatively,while 2 cases were lost.One flap for repair of the middle finger pulp shrank postoperatively and the bone was exposed.Stump revision was done.The other 20 flaps were with proper thickness,supple texture and good color.There was no donor site tendon adhesion or scar retraction that impairs joint movement.According to the criteria for functional assessment of the upper extremity issued by the Chinese Hand Surgery Society,the overall good-excellent rate was 87％.Conclusion Distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch is a satisfactory method for treatment of fingertip defects. Key words: Finger injuries; Surgical flaps; Treatment outcome; Proper digital nerves

Treatment of Soft-Tissue Loss with Nerve Defect in the Finger Using the Boomerang Nerve Flap

This study reports simultaneous repair of soft-tissue loss and proper digital nerve defect in the finger using a boomerang nerve flap including nerve graft from the dorsal branch of the proper digital nerve. From July of 2007 to May of 2010, the flap was used in 17 fingers in 17 patients. The injured fingers included five index, seven long, and five ring fingers. The mean soft-tissue loss was 2.5 × 1.9 cm. The mean flap size was 2.8 × 2.1 cm. Proper digital nerve defects were reconstructed using nerve graft harvested from the dorsal branch of the adjacent finger's proper digital nerve. The average nerve graft length was 2.5 cm. The comparison group included 32 patients treated using a cross-finger flap and a secondary free nerve graft. In the study group, 15 flaps survived completely. Partial necrosis at the distal edge of the flap occurred in two cases. At a mean follow-up of 22 months, the average static two-point discrimination and Semmes-Weinstein monofilament test results on the pulp of the reconstructed finger were 7.5 mm and 3.86, respectively. In the comparison group, the results were 9.3 mm and 3.91, respectively. The study group presented better discriminatory sensation on the pulp and milder pain and cold intolerance in the reconstructed finger. The boomerang nerve flap is useful and reliable for reconstructing complicated finger damage involving soft-tissue loss and nerve defect, especially in difficult anatomical regions. Therapeutic, II.

Finger Sensory Reconstruction With Transfer of the Proper Digital Nerve Dorsal Branch

To report reconstruction of proper digital nerve (PDN) defects using a nerve transfer from the dorsal branch of the uninjured PDN and compare the results with those of nerve grafting. A retrospective study was conducted with 17 consecutive patients who had PDN defects treated with a nerve transfer from the dorsal branch of the PDN from May 2007 to July 2009. The patients included 14 male and 3 female patients, with an average age of 32 years. There were 21 PDN defects in 20 fingers. The injured fingers included 5 index, 8 long, 5 ring, and 2 little fingers. The average length of the nerve defects was 2.3 cm (range, 1.4-3.5 cm). The uninjured dorsal branch of the other PDN of the same digit or the dorsal branch of the PDN of the adjacent digit was selected as a donor nerve. Neurorrhaphy was performed between the dorsal branch and the distal end of the PDN. For comparison, we collected a series of 31 patients with PDN defects treated with conventional sural nerve grafting. At a mean follow-up of 25 months (range, 20-26 mo), the mean static 2-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) scores on the finger pulp of the nerve transfer were 6.4 mm and 3.63, respectively. In the comparison group (mean follow-up, 23 mo; range, 19-27 mo), the mean static 2PD and SWM scores on the pulp were 9.2 mm and 4.10 mm. Significant differences were found in static 2PD and SWM results. Nerve transfer with the digital nerve dorsal sensory branch was useful for reconstruction of the PDN defect located between the proximal interphalangeal joint and the common digital nerve bifurcation. Sensory recovery using local nerve transfer was superior to conventional sural nerve graft. Therapeutic III.

Reconstruction of Proper Digital Nerve Defects in the Thumb Using a Pedicle Nerve Graft

Traumatic defects of the proper digital nerve in the thumb affect tactile perception of the thumb pulp. This article reports on the treatment of the defect using a pedicle nerve graft taken from the dorsal branch of the proper digital nerve of the index or long finger, or both. From May of 2006 to March of 2010, the pedicle nerve graft was used in 16 thumbs in 16 patients. There were 13 male and three female patients, with an average age of 33 years. Nerve repair was performed on one side in six thumbs and on both sides in 10 thumbs. The average length of the defects was 2.5 cm, between the middle of the distal phalanx and metacarpophalangeal joint. The average length of the nerve grafts was 2.7 cm. For comparison, we also collected a consecutive series of 27 patients with thumb proper digital nerve defects treated using a nonvascularized graft taken from the sural nerve (n = 15) or the medial antebrachial cutaneous nerve (n = 12). At a mean follow-up of 22 months, the mean static two-point discrimination and Semmes-Weinstein monofilament scores on the thumb pulps were 6.7 mm and 3.62, respectively. The measurements of patients treated using nonvascularized nerve grafts were 9.4 mm and 3.90, respectively. The outcomes of the two groups were significantly different. The pedicle nerve graft is useful and reliable for reconstructing proper digital nerve defects in the thumb. Superior sensory recovery was achieved using vascularized instead of unvascularized nerve grafts. Therapeutic, III.

Innervated Cross-Finger Pulp Flap for Reconstruction of the Fingertip

BackgroundFingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques.MethodsThis study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods.ResultsMost of the cases had cosmetically and functionally acceptable outcomes. The average defect size was 1.7×1.5 cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps.ConclusionsThe innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.

Symptomatic Neural Loop Causing Hemidigital Anesthesia: Case Report

Digital neural loops were identified over a century ago and are common findings in cadaveric studies of palmar and digital anatomy. Symptomatic digital neural loops are rare. We report a case of hemidigital anesthesia resulting from a proper digital nerve neural loop penetrated by its common digital artery in the palm. After neurolysis of the median nerve and the common and proper digital nerves to the third webspace, we transected the common digital artery, transposed it out of the neural loop, and repaired it. The patient's sensory symptoms fully resolved over 6 weeks. The differential diagnosis, diagnostic workup, and surgical treatment are reviewed.

Comparison of repair distal soft tissue defect with two kind of reverse digital artery island flaps

Objective To analysis the clinic outcome (similarities & differences, indication and caution) of repairing fingertip soft tissue defect with two kind of reverse digital artery island flaps with the palmar cutaneous branch of proper digital nerve. Methods From January 2000 to Auguest 2008, all 500cases (514 fingers) were repaired with reverse homodigital artery island flap (263 fingers of 250 cases) and reverse cross finger digital artery island flap(251 fingers of 250 cases).All cases were followed up from 3-8years,compared with flap range,finger extension,sensory rehabilitation,et al. Results All flaps (A & Bgroup) of 500 cases (514 fingers) survived.According to flap range,cross finger flap was better than homodigital flap (P ＜ 0.05); according to finger extension,homodigital flap better than cross finger flap (P ＜0.05); according to sensory rehabilitation,homodigital flap little better than cross finger flap(P ＜ 0.05); according to long-term follow-up, all had no obviously different (P ＞ 0.05). Conclusion Homodigital flap can cover distal soft tissue defect less than 2.0 cm× 2.5 cm, cross finger flap is a better choice for more than 2.0cm×3.0cm of distal soft tissue defect. According to the flap cover area, cross finger flap is first choice,and to finger extension & sensory rehabilitation,homodigital flap is first choice; accoding to finger movements,two kinds of flaps are all good choice. Key words: Homodigital flap; Cross finger flap; Island flaps; Finger; Microsurgery

Distal Sensory Nerve Transfers in Lower-Type Injuries of the Brachial Plexus

To report the results of sensory nerve transfers to reconstruct sensation on the ulnar side of the hand in lower-type palsies of the brachial plexus. From 2007 to 2009, we operated on 6 men and 2 women with a lower-type injury of the brachial plexus and observed them for a minimum of 24 months. The mean interval between the injury and surgery was 8 months (SD ± 8.6 mo). Before surgery, we documented anesthesia on the ulnar side of the hand in all patients. Donor nerves included cutaneous branches of the median nerve to the palm (n = 5) or the palmar cutaneous branch of the median nerve (n = 3). The ulnar proper digital nerve of the little finger was the recipient nerve. We evaluated sensory recovery by assessing static 2-point discrimination and sensation to Semmes-Weinstein monofilaments. According to the British Medical Council system of evaluation, 5 patients scored S3 and 3 scored S3+. In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand. Therapeutic IV.

One stage repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery

Objective To discuss the treatment and clinical efficacy of repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve. Methods The skin and nerve defect in 14 thumbs were repaired by dorsal island flap of index fingers based on the first dorsal metacarpal artery car- rying dorsal branch graft of digital proper nerve. The size of skin defect ranged from 52 mm x 32 mm to 10 mm x 8 ram. The length of the nerve defect ranged from 9 mm to 22 ram. Results The average follow- up was 6-35 months. All 14 flaps survived with satisfactory appearance and function. The injured side of thumb pulp sensation recovered $3 ＋ and the injured two-point discrimination ranged from 4 mm to 7 mm. No scar contracture or sensory dysfunction complication were observed in the donor sites. Conclusions The repair of soft tissue and nerve defect of thumb with dorsal island flap of index finger based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve is recommendable, since it can obtain satisfactory clinical efficacy and be easily and conveniently performed. Key words: Finger injuries ; Surgical flaps ; Sensation

Application of the island flap at the dorsum of the middle phalange with the pedicel of the digital proper artery

To explore a method for the treatment of the skin defects at the distal phalanges of 2-5th fingers. The island flap at the dorsum of the middle phalange was designed with the pedicle of dorsal branches from the digital proper artery. When the flap was used to repair defect at finger pulp, the dorsal branch of the digital proper nerve in the flap was kept to be anastomosed to the digital proper nerve at the recipient finger. From Feb. 2005 to May. 2010, 54 cases with skin defects at the distal phalanges of 61 fingers were treated with the flap, including 35 defects at finger pulp and 26 defects at finger tip. The maximum size of defects and flaps was 2.2 cm x 2.5 cm and 2.4 cm x 2.7 cm, respectively. 61 flaps survived completely. Blister was happened in 3 flaps 2 days after operation, which healed spontaneously without necrosis. 54 cases were followed up for 5 to 22 months (average, 11 months). The flaps had good texture and color match with normal sensation (grade S4). The 2-point discrimination distance was 6-9 mm. The interphalangeal joint had normal movement. The island flap at the dorsum of the middle phalange is an ideal method for the skin defect at the distal phalange of finger.