A new skin flap design for the repair of proximal phalanx base defects in flexion contractures of adjacent fingers

A random-pattern cutaneous flap with its base at the highly vascularized dorsal web space has been designed to decrease donor site deformity and to increase securely flap mobilization in contractures involving more than 1 adjacent proximal phalanx base. Rectangular flaps facing each other on the lateral sides of adjacent fingers have been raised on a single pedicle in the second, third, or fourth web space. The anatomic integrity of the web space was maintained and exposure of the metacarpophalangeal joints was avoided. Flap donor sites were reconstructed with full-thickness skin grafts. Since September 2000, 22 flaps were raised during a single-stage operation in 13 patients with an average age of 11 years at the time of surgery, and a total of 38 fingers have been reconstructed. The follow-up period averaged 24 months. The postoperative course was uneventful for all patients; all the flaps survived and the donor sites healed without complications. This flap, with its wide arc of rotation and minimal donor site morbidity, is easy to perform and is a good alternative in the reconstruction of multiple proximal phalanx base region flexion contractures of adjacent second, third, fourth, or fifth fingers.