Digital artery perforator flap for reconstruction of soft tissue defects of the finger distal to the distal interphalangeal joint - the functional outcomes

Authors

  • Tahera Akhter Department of Burn and Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  • M. Shahin Department of Burn and Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  • A. K. M. Muniruzzaman Department of Plastic Surgery, Shaheed Tajuddin Ahmed Medical College, Gazipur, Bangladesh
  • Nurun Nahar Happy Department of Burn and Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  • M. Obaidul Islam Department of Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  • M. Mosaddeque Hasan Asif Department of Burn and Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20254327

Keywords:

Digital artery, Perforator flap, Fingertip reconstruction

Abstract

Background: Fingertip injuries involving the distal phalanx often lead to functional and aesthetic impairment, requiring reliable reconstruction methods that preserve length, sensation, and mobility while minimizing donor site morbidity. The purpose of the study is to evaluate the functional outcomes of digital artery perforator flap reconstruction for soft tissue defects distal to the distal interphalangeal joint. The aim of the study was to evaluate the functional outcomes of digital artery perforator flap reconstruction for soft tissue defects distal to the distal interphalangeal joint

Methods: This prospective observational study at the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh (July 2018 to June 2019) included 20 patients with distal phalanx soft tissue defects. Flaps were raised on distal digital artery perforators, rotated 90°–180°, and donor sites closed primarily or grafted. Postoperative care included dressings, splinting, and early motion. Outcomes were assessed by goniometer; data were analyzed with SPSS v23.0.

Results: Among 20 patients, most were males (18, 90%) aged 16–25 years (9, 45%). Machinery injury was most common (9, 45%). Flap length 2.0–4.0 cm, width 1.0–2.0 cm. Wounds were mainly left-sided (11, 55%). Complications included venous congestion (11, 55%) and marginal necrosis (4, 20%), with donor sites mostly uneventful (18, 90%). Full DIP movement achieved in 11 (55%); flap outcome excellent in 14 (70%).

Conclusions: DAP flap provides reliable fingertip reconstruction with excellent functional outcomes without compromising the digital artery.

References

Kim KS. Digital Artery Perforator Flaps. Arch Reconstr Microsurg. 2015;24(2):50–5.

Paterson P, Titley OG, Nancarrow JD. Donor finger morbidity in cross-finger flaps. Injury. 2000;31(4):215-8.

Koch H, Kielnhofer A, Hubmer M, Scharnagl E. Donor site morbidity in cross-finger flaps. British J Plastic Surg. 2005;58(8):1131-5.

Duskova M, Jiri B, Adriana B, Vojtech S, Andrej S. Long Term Results of the Fingertip using the Thenar Flap. Clinics in Surgery. 2018;3:1–4.

Weeks PM, Wray RC. Management of acute hand injuries. A biological approach. St Louis, USA: Mosby Co; 1973.

Han SK, Lee BI, Kim WK. The reverse digital artery island flap: an update. Plastic Reconstruct Surg. 2004;113(6):1753-5.

Foucher G, Smith D, Pempinello C, Braun FM, Citron N. Homodigital neurovascular island flaps for digital pulp loss. J Hand Surge: British European Vol. 1989;14(2):204-8.

Yıldırım AR, İğde M, Tapan M, Öztürk MO, Yaşar B, Ünlü RE. Littler Flap: A reliable option in soft tissue defects of different fingers. Cumhuriyet Med J. 2016;38(4):332-9.

Woo SH, Seul JH. Distal thumb reconstruction with a great toe partial-nail preserving transfer technique. Plastic Reconstruct Surg. 1998;101(1):114-9.

Koshima I, Inagawa K, Urushibara K, Okumoto K, Moriguchi T. Fingertip reconstructions using partial-toe transfers. Plastic Reconstruct Surg. 2000;105(5):1666-74.

Tenekeci G. Perforator flaps: principles and techniques. Issues in Flap Surgery. London: IntechOpen; 2018: 37-4910.

Mardini S, Wei FC, Cheng MH. Free style free flaps. In: Blondeel P, Morris S, Hallock G, Neligan PC, editors. Perforator Flaps: Anatomy, Technique and Clinical Applications. St. Louis, MO: Quality Medical Publishing; 2006: 967–976.

Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004;114:910–6.

Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K, et al. Digital artery perforator flaps for fingertip reconstructions. Plastic Reconstruct Surg. 2006;118(7):1579-84.

Basat SO, Ugurlu AM, Aydin A, Aksan T. Digital artery perforator flaps: an easy and reliable choice for fingertip amputation reconstruction. Acta Orthop Traumatol Turc. 2013;47(4):250-4.

Yenidünya MO. The Most Challenging Reconstructive Procedure for God: Fingertip Reconstruction. Medical Journal of Islamic World Academy of Sciences. 2012;20(2):33-8.

Kostopoulos E, Agiannidis C, Konofaos P, Dounavis A, Papadopoulos O, Casoli V. Predictable pattern digital artery perforator flap: an alternative concept in digital reconstruction. Hand. 2016;11(1):88-96.

Shen XF, Xue MY, Mi JY, Qiang L, Rui YJ, Chim H. Innervated digital artery perforator propeller flap for reconstruction of lateral oblique fingertip defects. The Journal of Hand Surgery. 2015;40(7):1382-8.

Ozcanli H, Bektas G, Cavit A, Duymaz A, Coskunfirat OK. Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaed Et Traumatol Turc. 2015;49(1):18-22.

Lee M, Lee YK, Kim DH. The clinical result of arterialized venous free flaps for the treatment of soft tissue defect of the fingers. Medicine (Baltimore). 2019;98:23.

Zhu L, Xu Q, Kou W, Ning B, Jia T. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects. Indian J Orthopaed. 2014;48(6):594-8.

Downloads

Published

2025-12-30

How to Cite

Akhter, T., Shahin, M., Muniruzzaman, A. K. M., Happy, N. N., Islam, M. O., & Asif, M. M. H. (2025). Digital artery perforator flap for reconstruction of soft tissue defects of the finger distal to the distal interphalangeal joint - the functional outcomes . International Surgery Journal, 13(1), 45–50. https://doi.org/10.18203/2349-2902.isj20254327

Issue

Section

Original Research Articles