Direct and reversed flow proximal phalangeal island flaps.

The vascularization of the skin over the proximal phalanx was studied in 64 digital microdissections from eight fresh upper limbs injected via the brachial artery with latex neoprene. Two branches of the proper digital artery reached the dorsal aspect of the proximal phalanx to supply the skin. The proximal branch diameter was 0.2 mm in average, and the distal branch diameter was 0.4 mm in average. A vascular arcade overlying the extensor tendon border linked these branches. Based on the anatomic findings, two cutaneous axial island flaps are presented: the direct and reversal flow proximal phalangeal island flaps. Five direct proximal phalangeal island flaps were harvested from the hands of five patients. The clinical results were satisfactory; all the flaps survived well. These flaps are useful to repair skin losses over the proximal and middle phalanges.