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HYPOTHESIS Management of contractures and skin defects at proximal interphalangeal joint are a challenge for hand surgeons. We need a safe and easy flap to solve this cases.

METHODS We describe a new technique, a transposition flap taken from one lateral side of the proximal phalanx, based on reversal flow of one or two branches of collateral artery at proximal phalanx, that could be transposed to dorsal or palmar side of proximal interphalangeal joint. We made arterial injections in eight adult fresh cadavers, dissecting sixteen fingers, finding four skin branches from the collateral artery at proximal phalanx, same that describe Strauch, Voche and Braga Silva in other anatomic studies. Two more distal branches are located just at the proximal interphalangeal joint, and 7 milimeters proximal than this. This two branches together, or the more distal alone, are the vascular pedicle of our flap. Flap are taken from one side of proximal phalanx, previous defect measure. Vertex can be located at metacarpophalangeal joint, and can include part of web skin, reaching up to 3 cms of total length. Wide is calculated pinching lateral skin until we can close primarily donor defect, average 6 or 7 milimeters. We preserve all the fat tissue under the flap, over the collateral neurovascular bundle, and stop dissection 5 mm proximal to interphalangeal joint, ensuring that two more distal branches of collateral artery were included. If is necessary pivoting flap more distally, we can dissect more distal reaching PIP joint, where arise the more distal branch that can perfuse the flap alone. We can see arterial branches at flap undersurface in clinical cases and anatomic specimens, and a rich vascular network in all length of flap adipose tissue.

RESULTS We report 21 flaps in 18 patients between February 2010 and April 2012. No cases of necrosis, three flaps with distal epidermolisis and one more that had to be delayed (previous artery trauma). Patients are between 4 and 69 years and developed PIP contracture for burns, Dupuytren disease, etc. All patients resolved contracture and coverage defect satisfactorily.

SUMMARY This new flap take all advantages of the lateral skin of proximal phalanx, redundancy which allows primary closure, fingers sides are almost ever protected in burned hands. With a constant arterial pedicle and relative easy dissection our flap is a safe, reliable and reproducible technique that solve the challenge problem of contractures or coverage defects at proximal interphalangeal joint.