We report the results of pulp reconstruction with a new heterodigital rever
se flow island flap. A dorsolateral flap from the middle phalanx, based on
the digital artery is raised from the adjacent uninjured finger. The common
digital artery, between the injured fir;ger and the donor finger, is ligat
ed and transected just before its bifurcation. The two converging branches
of the digital arteries can be entirely mobilized as a continuous vascular
pedicle for the flap. Thus the vascularization is now supplied by reverse f
low through the proximal transverse digital palmar arch of the injured fing
er. To provide sensation the dorsal branch of the proper digital nerve from
the donor finger can be included in the flap. Sis reverse heterodigital is
land flaps were used in patients. In five patients the flap was used for pu
lp reconstruction and in one case for covering a dorsal digital defect. In
one case mild venous congestion occurred. Good skin coverage with supple an
d well-vascularized skin was obtained in each patient. The static two-point
discrimination over the flap was between 6 and 15 mm.
This new procedure is indicated for extensive pulp defects in fingers in wh
ich reconstruction cannot be done using other flaps and as an alternative t
o microsurgical reconstruction.