A series of complex fingertip injuries managed with a reversed digital
artery island flap is presented. An island of skin on the side of the
proximal phalanx can be elevated on a digital arterial pedicle and ro
tated to the fingertip to provide abundant skin and subcutaneous cover
age for acute or chronic deficits. The flap receives retrograde flow f
rom its ipsilateral digital artery after passage through dorsal and pa
lmar vascular plexuses at the middle and distal phalangeal level. Thir
teen flaps were performed on eleven patients with no loss of any porti
on of the flap. The advantages of this procedure include a reconstruct
ion that necessitates surgery only on the injured digit, allowing for
the treatment of single or multiple fingertip injuries that provides f
unctional sensation in the reconstructed fingertip without causing los
s of motion.