Direct and Reversed Dorsal Digital Island Flaps: A Review of 65 Cases

Reconstruction of soft tissue defects in the fingers continues to be a challenge problem. The study reports reconstruction of small to moderate defects of the fingers with the direct and reversed dorsal digital island flaps and evaluates the results of the use of the flaps.The main outcomes are static 2-point discrimination and Semmes-Weinstein monofilament scores of the flap and joint motion.

At final follow-up, sensory restoration of the flap is measured using the static 2-point discrimination (2PD) test and Semmes-Weinstein monofilament (SWM) test. Active motion of the joints is measured using a standard hand goniometer. For the direct DDIF, total active motion is calculated as the sum of degrees of active flexion of the interphalangeal and the metacarpophalangeal joints subtracted from the degrees of extension deficit. For the reversed DDIF, total active motion of the donor finger is calculated as the sum of degrees of active flexion of the proximal and distal interphalangeal joints subtracted from the degrees of extension deficit.

Inclusion Criteria:

• a defect greater than or equal to 1.5 cm in length
• the defects on the dorsal and lateral aspects of the fingers
• the defects located between the distal 1/2 of the middle phalanx and the tip of the finger
• a patient between 15 and 60 years of age.

Exclusion Criteria:

• injuries involving the donor sites or the course of the vascular pedicle
• a defect less than 1.5 cm in length.