A modified adipofascial propeller flap for the dorsal fingertip

BACKGROUND: Adipofascial Lai flap is the principal surgical option to reconstruct the dorsal distal digital defects and nail bed lesions but it is limited by some complications, i.e. the recurrence of residual painful nail. Our original modification of the Lai flap with our case series of 12 dorsal adipofascial propeller turn-over perforator flaps specifically used to reconstruct the nail bed is presented. Any painful residual nail or onicodystrophia was detected with a good functional and aesthetic outcome. METHODS: All the cases of finger distal dorsal soft tissue defect treated at the authors’ institutions with the adipofascial modified turn-over flap between 1st January 2000 and 31st December 2010 were included in the study and clinically observed. All patients were checked at 1, 6 and 12 months. RESULTS: Twelve fingers of 12 subsequent patients were included. In all the cases the nail bed was damaged but the residual integrity of the fertile nail matrix ensured regrowth of the nail lamina. The average healing time in our series was 20±4 days. All the soft tissue defects resulted fully covered, no failure of the flap was reported and donor site morbidity was minimal and generally well accepted by patients in all cases and during all follow-up. CONCLUSIONS: This flap represents a reproducible, simple and rapid one stage technique with poor morbidity for the donor site and minimal residual scar on the defect area.