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PURPOSE: The possibility of harvesting flaps based on digital perforators located at DIPJ was described by Koshima, for covering very distal finger defects. We will demonstrate that it is possible to harvest such flap also more proximal. More, in those cases when the direct closure of the donor site is not possible, a bilobed flap blood supplied by the same perforator vessels can be used.

METHODS: We will present the advantages of using these mini flaps based on perforators emerging from the digital arteries, at any level of the fingers, including the thumb. In our service were practiced 25 transposition island perforator flaps for covering tissue defects in fingers, from which 4 were for the thumb. In 2 cases we used the perforator flap as a cross-finger flap, to cover a defect on an adjacent finger. The transposition flaps have an oval shape, are harvested from one side of the finger, without sacrificing the digital artery. After the subfascial undermining of the flap on its entire surface and identification of the vascular pedicle represented only by the perforator, the flap can be rotated 90-180° and can cover dorsal and volar finger defects. The flap’s donor site is generally directly closed; if its direct suture is not possible, a free skin graft from the forearm can be used. In the attempt to avoid this disadvantage, we developed a bilobed pedicled flap blood supplied by the same perforator vessels, which allows the donor site closure without any morbidity. This flap was used in 13 cases.

RESULTS: These transposition flaps had an uneventful evolution, with complete integration of the flap and good quality functional recovery. In 2 cases we registered a minute partial superficial necrosis, which spontaneously healed. The bilobed flaps had also an uneventful evolution. The recovery for all the patients was between 14-21 days.

CONCLUSION: We consider that the perforator island transposition flaps have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, can be sensate, and the donor site can be generally directly closed. Whwn the direct closure of the donor site cannot be realised, this one can be achieved by using a free skin graft or the bilobed flap as a variant of the perforator flap.