‘Front and Back’ Flaps for Multiple Dorsal and Palmar Digital Skin Loss

We describe a technique modification of the 'many tailed' flaps for multiple digital defects in adjacent digits described in 1980. This is a versatile technique for providing cover to multiple palmar and dorsal defects of the digits, avoiding the need to syndactylize digits, and when it is not desirable or adequate to perform multiple local flaps to cover the losses. The technical modifications are use of donor closure to adjust the position of the flaps in opposition, sequential donor closure to accurately place subsequent flaps, and raising flaps from less to more lax donor skin to avoid drift of donor site position.