Clinical application of modified dorsal island flap of index finger for repairing the soft tissue defect of thumb tip

Objective To investigate the therapeutic effect of modified dorsal metacarpal artery island flap of index finger without skin graft in repairing different types of soft tissue defect of thumb tip. Methods From August, 2015 to October, 2017, 25 patients with soft tissue defect of the thumb tip were included in the study. Sixteen cases were males and 9 cases were females. Seventeen defects were in thumb dorsal and 8 cases were in thumb pulp. A modified dorsal island flap of index finger was used and the dorsal metacarpal superficial vein fascial flap could be harvest and combined to repair the thumb pulp defect if necessary. A relaying perforator flap pedicled on the second dorsal metacarpal artery was raised through the same incision to cover the donor site without skin graft. Followed-up was made by clinic, telephone and WeChat. Results The patients were followed-up for 6 to 18 months. All flaps survived completely without complications. The color, texture and contour of the flaps was good. Only 1 linear scar was left in the dorsum of the hand and no skin grafts. The second dorsal metacarpal artery flap was used to cover the donor site. Twenty-one cases (84%) were satisfied with the postoperative appearance of the thumb. The function was assessed as excellent in 16 fingers, good in 6 fingers and fair in 3 fingers. No complication occurred in the donor site. Conclusion It is possible to use the modified dorsal island flap of index finger to repair different types of thumb tip defects. A second dorsal metacarpal artery flap can be used as a relaying flap to cover the donor site without skin grafts. Key words: Thumb tip; Index finger; Island flap; Surgical modification; Microsurgical technique