Optimizing Fingertip Reconstruction: A Comparative Analysis of Reverse Homodigital Island and Digital Artery Perforator Flaps

Background

Fingertip amputations are a common form of hand trauma and often require soft tissue reconstruction when replantation is not feasible. The reverse homodigital island flap (RHI) and the digital artery perforator flap (DAP) are two widely used techniques for fingertip reconstruction; however, direct comparisons of their clinical outcomes remain limited.

Methods

This retrospective study analyzed 39 patients who underwent either RHI (n = 20) or DAP (n = 19) procedures for fingertip injuries. Patients with thumb injuries, multiple finger injuries, or insufficient follow-up data were excluded. Postoperative management included flap monitoring, limb elevation, and early rehabilitation. Outcomes assessed included flap survival, operative time, hospital stay, functional recovery, and complications such as flap congestion, necrosis, and nail deformities.

Results

No significant differences were found in baseline characteristics or affected digits. The RHI group mainly involved Ishikawa subzone II injuries with avulsion patterns, while the DAP group had predominantly subzone I crush injuries. Distal phalanx bone defect length was comparable between groups. Both RHI and DAP demonstrated high flap survival rates, with no cases of major necrosis. The mean operative time was significantly shorter in the DAP group (68 min) compared to the RHI group (101 min, p < 0.001). Similarly, the hospital stay was shorter in the DAP group (13 days) than in the RHI group (18 days, p < 0.05). While both flaps achieved good functional and sensory recovery, the DAP group exhibited a lower secondary procedure rate (21.1%) compared to the RHI group (70%, p < 0.002). However, nail deformities, particularly claw deformities, were more frequently observed in the DAP group (47.4%).

Conclusion

The DAP flap offers a shorter operative time, faster recovery, and a lower secondary procedure rate, making it a preferable option for functional reconstruction. In contrast, although the RHI flap requires a longer treatment period, it may provide superior esthetic outcomes.