Arch Hand Microsurg.  2020 Dec;25(4):282-286. 10.12790/ahm.20.0047.

Fingertip Reconstruction with Subcutaneous Island Flap and Composite Graft: A Case Report

• Park J
• Kim JS
• Koh SH
• Lee DC
• Roh SY
• Lee KJ
• Hong MK

• KMID: 2508941
• DOI: http://doi.org/10.12790/ahm.20.0047

Abstract

Reconstruction of amputated fingertips is extremely challenging when the amputee is very small and severely crushed. Moreover, there are not many options if distal phalanx is exposed due to defects of soft tissue. We report a case of successful fingertip reconstruction in a 10-month-old girl using a subcutaneous island flap with a composite graft. Her fingertip of the right little finger was amputated stuck by the air purifier. Some soft tissue was lost from the stump and the bone was exposed. There was a very small amputee, and soft tissue was extremely little inside. Replantation was not possible because of the soft tissue defect. The composite graft was inadequate due to the exposure of distal phalanx and defect of soft tissue. Soft tissue island flap based terminal branch of the digital artery was transposed to cover the distal phalanx. After then, the amputee was grafted over the flap. After debridement, most of the soft tissue survived and 0.2×0.2 cm of skin defect was found, which was healed through secondary intention.

Keyword

Island flap; Fingertip; Reconstruction

Figure

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  Fig. 1. (A, B) A 10-month-old girl presented with amputation of a fingertip in the right little finger. (C, D) There was loss of soft tissue on the stump with exposed bone.

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  Fig. 2. Subcutaneous island flap based on distal transverse palmar arch was elevated.

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  Fig. 3. The flap was transposed to cover exposed distal phalanx.

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  Fig. 4. A composite graft was done over subcutaneous island flap with amputee.

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  Fig. 5. (A) Minimal skin defect remained after debridement. (B) Three months after debridement, full epithelialization finished.

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  Fig. 6. Schematic diagram of the subcutaneous island flap.

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