Nerve Sparing Antegrade Homodigital Island Flap

Background: Fingertip reconstruction requires stable,sensate, and painless padding. Digital defects proximal to thetip around distal interphalangeal joint or dorsal raw areaspreclude these objectives except for preserving the sensationto the fingertip. Antegrade Homodigital island flap accomplishesthese objectives for fingertip defect coverage.Objective: In this case series, we modify this flap to coverdifferent defects proximal to the fingertip while sparing thedigital nerve to preserve fingertip sensation.Material and Methods: Between March 2019 till June2022 Fourteen patients (fifteen finger) with deformed distalphalanges, contracted distal interphalangeal joint, or defectssparing the finger tips were treated with a nerve sparingantegrade homodigital island flap. The mean age was 27±17years old. The etiologies were post-traumatic, post-burn orfirearm injury. Follow-up period ranged from 4-18 months.Results: All flaps survived with delayed wound healingin two flaps and proximal interphalangeal joint 15 degrees'extension lag in one patient. Fingertip sensation was preservedin all patients with mean 2 point-discrimination (2PD) test3±1mm. We evaluated patient satisfaction regarding cosmeticand functional outcomes.Conclusion: Nerve sparing antegrade homodigital islandflap is considered a reasonable choice for covering fingerdefects proximal to the fingertips. It provides durable, robust,and aesthetically accepted coverage.