Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects

Purpose: To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations.

Methods: Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2.5 × 1.5 cm to 3.0 × 2.0 cm.

Results: All flaps survived entirely and restored a rounded fingertip contour. Mean static 2-point discrimination was 5 mm (range, 4-6 mm). With the exception of 1 patient with an amputation at the distal interphalangeal joint, the distal interphalangeal joint was preserved in all patients and had 30° to 60° of motion at final follow-up. No patients complained of cold intolerance or residual joint contracture. No hooked nail deformity occurred in patients who had remaining nailbed.

Conclusions: The digital artery perforator propeller flap is particularly suited to coverage of a lateral oblique fingertip defect, because only a 90° rotation is required when inset, and the bulk of the flap serves to restore the rounded contour of the fingertip. The skin over the entire dorsal surface of the middle phalanx can be elevated as a flap, providing adequate tissue to resurface the defect and restore a rounded contour to the fingertip.

Type of study/level of evidence: Therapeutic IV.