Long-term outcome of dorsal digital defect reconstruction using reverse-cross-finger flaps

Abstract

Purpose

Despite advances in microsurgical reconstruction, the reverse cross-finger flap (RCF) remains a reliable technique for dorsal finger defects. However, long-term outcome data are limited. This study evaluates the clinical and subjective long-term outcomes of patients treated with RCF reconstruction.

Methods

A retrospective single-center cohort study was conducted on patients who underwent RCF for dorsal finger defects between 2003 and 2022. Nineteen patients (mean age 59.0 ± 20.1 years) were included in the follow-up (mean duration: 12.6 ± 6.1 years). Functional outcomes were assessed via range of motion (ROM), two-point discrimination, and cold intolerance. Subjective satisfaction and functional limitations were evaluated using the Quick-DASH and a custom survey. Complications and aesthetic results were also recorded.

Results

All flaps fully integrated. Complications were: 2 infections, 1 hematoma, and 1 partial flap necrosis requiring revision. Mean two-point discrimination was 7.6 mm (vs. 5.8 mm contralaterally; p < 0.05), and cold intolerance occurred in 9 cases. ROM showed no significant differences compared to the contralateral hand. Mild activity-related pain was reported by 6 patients, with no resting pain. Mean satisfaction scores were 8.1 (functional) and 7.7 (aesthetic). The mean Quick-DASH score was 5.1.

Conclusion

The RCF remains a safe, effective, and durable option for dorsal finger reconstruction. It offers reliable functional and aesthetic outcomes with low donor site morbidity and complication rates, supporting its continued role in modern hand surgery, particularly where microsurgical resources are limited.