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The Anterograde Homo-Digital Neurovascular Island Flap for Reconstruction of Fingertip Injuries
Ryan D. Katz, MD1; Ramon DeJesus, MD2
1Curtis National Hand Center, Baltimore, MD; 2Hand Surgery, Upper Chesapeake/Union Memorial Hospitals, Bel Air

Introduction
Fingertip injuries are the most common type of upper extremity injury. There are numerous techniques described for fingertip reconstruction. The most effective methods resurface the pulp with sensate glabrous skin. The aim of this study is to present the authors experience reconstructing fingertip defects utilizing the Anterograde Homo-Digital Neurovascular Island Flap (AHDNIF).

Methods
5 fingertip trauma defects underwent reconstruction utilizing this flap. Static two-point discrimination, flap viability, distal interphalangeal joint stiffness, cold intolerance, DASH scores, hypersensitivity and donor site morbidity were assessed.

Results
Our small series acquired adequate pulp coverage. We experienced no partial or complete flap loss. The flap was utilized for subtotal and total pulp defects. Full thickness skin graft was used to resurface the donor defect in all cases. All flaps were immediately sensate on the first postoperative visit. An average of 4mm 2pd was obtained at 3months. There were no flexion contractures.

Conclusion
The (HDANAF) is a good alternative for fingertip defects. It provides single-staged (like with like) pulp coverage with immediately sensate, glabrous skin. The technique is safe and reproducible. It can be done with local anesthesia and loupe magnification. In contrast to the retrograde homodigital flap, it requires no neurrhaphy to acheive sensation.


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