Performing the dorsal cross-finger flap
Fig. a) Preoperative defect, b) raising the flap taking the mid-lateral line into account, c) transposition of the flap into the defect, d) after insetting the flap
After selecting the donor finger, the dimensions of the defect are transferred to the dorsal side of this finger. The base of the flap is located on the side opposite the defect. Functional units must be preserved, and the defect may need to be extended palmarly by incision (mid-lateral line).
After the dorsal skin incision, dissection is carried out from the tip of the flap to its base at the level of the mid-lateral line, consistently preserving the paratenon. The large subcutaneous veins must be ligated. The skin bridge must be long enough to leave sufficient play (several millimetres) between the fingers and to prevent compression of the flap base. The flap is then transposed through 180°, like the page of a book, palmarly into the defect.
After releasing the tourniquet, it may be useful to place two strong “babysitter” sutures between the adjacent fingers to prevent traction and compression on the pedicle. The donor-site defect can be covered with a medium-thickness split-thickness skin graft or a full-thickness skin graft. The dressing must include proper padding of the interdigital region to avoid maceration. In addition, compression of the pedicle must be prevented.
Source: Die Handchirurgie, M. Sauerbier, A. Eisenschenk, H. Krimmer, B.-D. Partecke, H.-E. Schaller (Hrsg.)
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