Vascularized tendon incorporated in reverse homodigital and heterodigital island flaps for the reconstruction of dorsal digital defects

Background: An adequate range of motion (ROM) of the distal interphalangeal (DIP) joint is indispensable for fine motor skills of the hand. Reconstruction of extended skin and tendon loss of the distal phalanx is often challenging for surgeons and may lead to functional impairment of the injured finger. This article presents an option for a one-step functional and esthetical reconstruction of dorsal digital defects using combined island flaps. Methods: Vascularized tendons were harvested incorporated in reverse homodigital and heterodigital island flaps to treat skin and extensor tendon loss of patients over their DIP joints. In a 6-month follow-up, we evaluated the active ROM and fine motor skills of the involved fingers as well as the patients' satisfaction. Results: Six months postoperatively satisfactory functional and sensory results of the donor site finger have been reported. The mean ROM for the recipient finger was 0 degrees/25 degrees for the DIP joint. All flaps remained viable and full finger length was preserved. Patients stated adequate till high satisfaction with respect to operation time, pain, and finger appearance. Conclusion: The vascularized tendon incorporated in reverse island flaps provides a sufficient method to restore function of the DIP joint after complex injury and prevents finger deformity, arthrodesis, or amputation. (C) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.