Innervated reverse island flap based on the dorsal cutaneous branch at distal interphalangeal joint of digital artery

Objective To introduce a new idea of fingertip or pulp reconstruction with the innervated reverse island flap based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery.Method Based on the features of blood supply and innervation of digital dorsum,it was harvested for coverage of fingertip or pulp defects for 5 cases of the reverse island flap from the dorsum of the middle phalanx based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery.Meanwhile,the sense was reconstructed with the proper branches of the digital dorsal nerves. Results All cases survived completely.After following up of 3～6 months,the fingers after reconstruction had satisfactory appearances,soft texture with wear-resisting,without tenderness.No cold intolerance of the involved fingertip or pulp was reported.Static and moving two-point discrimination was 4～6 mm and 2～4 mm respectively.There were no apparent complications in the donated places,and the movements of interphalangeal joints decreased less than 10 degrees. Conclusion The method is one of the one-stage local flaps.It does not require the sacrifice of a collateral digital artery,which may jeopardize an already injured finger,and it leads little disturbance of functional and aesthetic at the donor site.In addition,the sense is regained successfully.It is a good alternative for one-stage reconstruction of fingertip or pulp defects.