Repair of dorsal defects over the middle phalanx and proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx.

PURPOSE: We report the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of soft tissue defects on the dorsum of the middle phalanx and proximal interphalangeal joint involvement.

METHODS: From October 2005 to November 2008, we treated 16 digits in 16 patients in our unit. There were avulsion (n = 3), third-degree burn (n = 7), and crush (n = 6) injuries. The mean flap size was 2.3 × 1.8 cm (range, 1.8 × 1.7 cm to 2.6 × 2.3 cm). The mean pedicle length was 1.7 cm (range, 1.0-2.3 cm). At follow-up, we measured active joint motion. The scar pain at the donor site was determined by the patient's self-reported assessment. We measured cold intolerance using the self-administered Cold Intolerance Severity Score questionnaire.

RESULTS: All flaps survived completely. At the final follow-up after 2 years, the mean active motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 90°, 105°, and 57°, respectively. All scars on the donor sites were painless. All patients were mildly cold intolerant.

CONCLUSIONS: This transposition flap raised from the dorsum of proximal phalanx is useful and reliable for coverage of a dorsal defect over the middle phalanx and proximal interphalangeal joint with minimal donor site morbidity.