A patient presented with a traumatic exposure of the index finger proximal phalangeal joint (PIPJ) with partial extensor tendon loss. Injury to the adjacent finger precludes the reverse cross finger flap. The finger joint is stabilized with a k-wire. An adipofascial flap was chosen for coverage. Adipofascial turndown flaps are random pattern flaps utilizing the subcutaneous layer to provide soft tissue coverage for small joints and bone. On the finger, its most valuable application is dorsal coverage of an open PIPJ. Reverse cross finger flaps from adjacent fingers often cannot be utilized, as dorsal tissue from the PIPJ should not be sacrificed to cover an adjacent finger injury.
Two basic tenets of this flap are that the area of the flap is no more than 4 times the area of the “base” from which the flap depends for blood supply. Second, the design of the flap must include the base to allow the flap to be “turned down” over the base and still provide ample coverage.
The defect measures roughly 1.5 x 2 cm. The base, measuring 0.5 cm x 2 cm is drawn out. The flap must then be 2.0 cm x 2 cm to cover both the base and the defect. The area of the flap, 4 square cm, is no more than 4 times the area of the base, which is 1 square cm.
A key technical challenge to this flap is elevation of the skin dermis directly off the subcutaneous layer, leaving the subcutaneous “flap” undisturbed. The skin flaps are elevated the length of the flap and base.
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