The authors report on a series of 3 dorsal middle phalangeal finger (DMF) flaps, first described by Buchler and Frey in 1988. The flaps are based on the dorsal arteriovenous system and can be neurotized by inclusion of dorsal nerve branches. The flaps were used to cover defects of the dorsal nail bed and distal phalangeal bone, dorsal PIP joint and extensor tendon, and distal phalangeal amputation. One flap was anastomosed as a flow-through flap. One flap was neurotized using the dorsal branch of the digital nerve. All flaps survived. Excellent range of motion was preserved in the flap used to cover the intact PIP joint. 5mm 2-pt discrimination was returned to the tip of the neurotized finger flap. No complications were reported.
The authors report on their successful series of 3 DMF flaps to cover defects of adjacent fingers. They cite advantages over pedicled island flaps as limited arterial dissection without the need to sacrifice a proper digital nerve in the donor finger, the possibility of reconstructing the digital donor vessel when necessary, and the avoidance of venous congestion after flap transfer. Although these advantages appear to be valid, it is not clear whether or not they outweigh the increased operative time, necessary expertise, and cost of the procedure, as there is no comparison of results due to lack of a control group.
Free, Flap, Microsurgery, Dorsal, Finger