BACKGROUND: The heterodigital arterialized island flap is a versatile flap providing robust, vascularized, nonsensate soft-tissue cover for the reconstruction of sizable digital defects. Routine inclusion of a dorsal vein augments venous drainage and minimizes postoperative congestion. To extend the reach and versatility of the flap in resurfacing larger digital defects and defects in awkward areas such as the dorsal surface, distal fingertip, and far sides of border digits or thumb, a modification is proposed. METHODS: The authors' experience with this technique in 12 patients with digital soft-tissue defects is reviewed. Defect sizes ranged from 2.0 to 4.5 cm in length and from 1.0 to 2.5 cm in width. By positioning the finger defect to the flap and creating a temporary bridging tissue pocket at the base of the fingers to site the flap pedicle, the flap is applied to defects of adjacent digits in a cross-finger fashion. Division and inset of the flap are performed 3 weeks later. RESULTS: Complete survival and primary healing was achieved in all the flaps, without evidence of venous congestion. Donor morbidity was acceptable. All donor fingers retained normal fingertip sensation and had minimal stiffness, with return of excellent to good total active interphalangeal joint motion. CONCLUSIONS: The cross-finger modification of the heterodigital arterialized flap extends the reach of the flap and versatility of application, delivering a good cosmetic result while minimizing the amount of proximal dissection required, and has minimal donor morbidity.
BACKGROUND: The heterodigital arterialized island flap is a versatile flap providing robust, vascularized, nonsensate soft-tissue cover for the reconstruction of sizable digital defects. Routine inclusion of a dorsal vein augments venous drainage and minimizes postoperative congestion. To extend the reach and versatility of the flap in resurfacing larger digital defects and defects in awkward areas such as the dorsal surface, distal fingertip, and far sides of border digits or thumb, a modification is proposed. METHODS: The authors' experience with this technique in 12 patients with digital soft-tissue defects is reviewed. Defect sizes ranged from 2.0 to 4.5 cm in length and from 1.0 to 2.5 cm in width. By positioning the finger defect to the flap and creating a temporary bridging tissue pocket at the base of the fingers to site the flap pedicle, the flap is applied to defects of adjacent digits in a cross-finger fashion. Division and inset of the flap are performed 3 weeks later. RESULTS: Complete survival and primary healing was achieved in all the flaps, without evidence of venous congestion. Donor morbidity was acceptable. All donor fingers retained normal fingertip sensation and had minimal stiffness, with return of excellent to good total active interphalangeal joint motion. CONCLUSIONS: The cross-finger modification of the heterodigital arterialized flap extends the reach of the flap and versatility of application, delivering a good cosmetic result while minimizing the amount of proximal dissection required, and has minimal donor morbidity.