Double Fillet Flaps from a Single Digit for Adjacent Finger Salvage

Fillet flaps are a well-established reconstructive alternative in the context of unsalvageable limb injuries. The use of the resulting “spare parts,” in the form of axial-pattern flaps, can provide suitable cover for adjacent defects.[1] Even though many reports of the use of this technique can be found in the literature,[2] [3] to our knowledge the utilization of two separate fillet flaps from a single digit for the reconstruction of adjacent fingers has not been reported.

We present the case of a 26-year-old male patient who was referred to our unit after sustaining right hand injuries in a rollover road traffic accident. This resulted in an isolated but severe mangling injury with open fractures to his index, middle, and ring fingers involving extensive dorsal skin loss ([Fig. 1]). Whereas the index and ring fingers were deemed salvageable, the middle finger was not, due to extensive bone loss involving its middle phalanx and severe proximal and distal interphalangeal joint destruction. Following radical surgical debridement, the ring finger distal interphalangeal joint was fused and so too was the proximal interphalangeal joint of the index finger ([Fig. 2]); extensive compound dorsal defects were present in the index and ring fingers.

Fig. 1 Preoperative photographs taken in the emergency department. Open fractures with extensive dorsal soft tissue loss to the right index, middle, and ring fingers can be seen.

Fig. 2 Postoperative radiographies showing the methods of fixation for the salvaged right index and ring fingers, with the terminalized middle finger that donated the fillet flaps. AP, anteroposterior.

The middle finger was de-skeletonized distal to the proximal interphalangeal joint, and two separate fillet flaps were harvested, each one relying on a digital neurovascular bundle. This maneuver provided two pedicled, glabrous-skin flaps that were interpolated to the dorsum of the adjacent digits. Successful division of these flaps pedicles was undertaken 3 weeks postoperatively resulting in adequately perfused flaps ([Fig. 3]).

Fig. 3 (A) Postoperative photograph at 3 weeks after the injury, showing the inset of the opposing fillet flaps into adjacent digits just before division. (B) Postoperative photographs 8 weeks after the division of the fillet flaps.

For this unusual case, the utilization of double fillet flaps from an unsalvageable finger provided adequate soft tissue cover for the adjacent fingers. This technique avoided the need for more complex alternatives, such as regional flaps and soft tissue transfer with the associated donor site morbidity. We believe that this technique provides a safe alternative for the rare situation of having an unsalvageable middle or ring finger and adjacent finger injuries.

Publication History

Received: 04 March 2019

Accepted after revision: 22 March 2019

Article published online:
26 June 2019

• References

• 1 Küntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical valu. Plast Reconstr Surg 2001; 108 (04) 885-896
• 2 Kokkoli E, Spyropoulou G-A, Shih H-S, Feng G-M, Jeng S-F. Heterotopic procedures in mutilating hand injuries: a synopsis of essential reconstructive tool. Plast Reconstr Surg 2015; 136 (05) 1015-1026
• 3 Johnson RM, Peters PG. Forked finger fillet flap for segmental extensor tendon coverage of an adjacent digi. J Burn Care Res 2008; 29 (03) 548-550