The perforator-based axial adipofascial turnover flap combined with juncturae tendinum grafting for complex dorsal phalangeal defects

INTRODUCTION: Complex dorsal finger soft tissue defects remain a challenging reconstructive problem, particularly when associated with exposure of bone and extensor apparataus. Advances in the anatomical understanding of the dorsal cutaneous vascular system of the digits have allowed adipofascial flaps in this region to evolve from random-pattern to axial-pattern designs, improving vascular reliability. However, a structured and comprehensive approach for managing these combined defects has not been clearly defined in the literature. This study aims to present a holistic loco-regional strategy that optimizes the reconstructive ladder while minimizing donor-site morbidity and technical complexity. MATERIALS AND METHODS: This clinical series includes seven fingers with complex soft tissue defects involving the dorsal aspect of the middle and distal phalanges. All cases were managed using an ipsilateral loco-regional protocol consisting of three components: (1) an extended axial adipofascial turnover flap for soft tissue coverage, (2) tendon reconstruction using juncturae tendinum harvested from the fourth intermetacarpal space, and (3) full-thickness skin grafting from the wrist. Patients were followed for a minimum of six months. Functional outcomes were evaluated by range of motion and complication rates. RESULTS: Complete flap survival was achieved in all cases. All fingers demonstrated satisfactory functional outcomes with acceptable flexion and extension ranges of motion at follow-up. No major complications, including infection, osteomyelitis, or significant donor-site morbidity, were observed. CONCLUSIONS: The perforator-based axial adipofascial turnover flap combined with juncturae tendinum grafting provides reliable single-stage reconstruction of complex dorsal finger defects without the need for microsurgical anastomosis. This structured loco-regional approach enables immediate reconstruction without the need for microsurgical equipment or advanced microvascular expertise, offering a practical and reproducible alternative within the reconstructive ladder. LEVEL OF EVIDENCE: IV.