THE PERIOSTEO-CUTANEOUS FLAP FOR DISTAL FINGERTIP INJURIES
Alexander J Kaminsky1 MD MPH, John Grismly2 MS, Shitel Patel1 MD, Vineet Mehan3 MD
1. Inova Fairfax Hospital, Falls Church Va
2. Georgetown University School of Medicine, Washington DC
3. Private Practice, Falls Church Va
Abstract
Introduction: Traumatic fingertip defects, often requiring reconstruction, are a common injury seen by
plastic surgeons. The aim of fingertip reconstruction is to provide durable coverage of the tip, preserve
functional length, maintain function, and provide a quick return to pre-injury activity. While there are
many technical options for managing these injuries, no clear gold standard has emerged. The novel flap
design includes dissecting a subperiosteal plane along the injured distal phalanx volar aspect and then
incising the periosteum distal to the insertion of the flexor tendon and pulling the soft tissue envelope
forward along with its neurovascular bundle. This periosteo-cutaneous flap design addresses and
minimizes the disadvantages of previously described techniques while providing the goals of reliability,
feasibility, expedience, function preservation, tactile sensation preservation, length preservation and
achieve a good aesthetic outcome.
Methods: Between 2010 and 2014, 70 patients underwent reconstruction of fingertip injuries by one
senior author (VM) using the periosteo-cutaneous flap at INOVA Fairfax Hospital, 9 of which met criteria
for inclusion, and were available for followup at the level of date required for analysis. Outcomes were
evaluated based on flap viability, function (QuickDASH), sensation (2 point discrimination test and cold
intolerance), range of motion, and aesthetics.
Results: The mean active range of motion (ROM) values were 64.3 degrees for the DIP joint (range 40 90), 76.9 for the PIP/IP joint (50 - 90) and 73.4 for the MP joint (range 50 - 90). The mean QuickDASH
score was 3.51 (Range 0 - 9) and the mean cold intolerance score was 2.22, 5.22 (range 0,0 - 6,16).
Mean aesthetic outcome score was 4.33 (range 3 - 5). Mean 2-point discrimination test was 3.11 on the
ulnar side of the repaired digit (range 2 - 4) and 2.56 on the radial side (range 2 - 4).
Discussion: Proper reconstruction of the fingertip is of vital importance in effort to retain fine motor skills,
precise sensation and hand aesthetics. The periosteo-cutaneous flap is best suited for reconstructing
dorsal oblique and transverse amputations. The results demonstrate the perioesto-cutaneous flap can
preserve function, maximize sensibility, length and achieve a acceptable aesthetic outcome. Additionally,
it is a quick, reliable, and simple method that takes advantage of the more superficial plane of the
neurovascular bundle. No fixation to another portion of the hand or adjacent finger We feel this technique
offers a safe and effective alternative to other established fingertip reconstructions, minimizes
immobilization times or issues with stiffness often seen with thenar or cross finger flaps. The periosteocutaneous flap is safe, reliable, and should be apart of the armamentarium of procedures for hand
surgeons who encounter distal fingertip injuries.