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In 1998, we reported on 120 fingers in 110 consecutive patients who were treated with reverse digital artery island flaps for fingertip reconstructions. The purpose of this follow-up study is to emphasize a couple of changes in our procedures since the original study. First, we do not employ sensate flaps any more. Second, digital artery is separated more distal than the original report, to the level of distal interphalangeal joint in some cases. Lastly, flap design in a stellate shape is recommended to avoid scar contracture. Twenty-eight additional patients(fingers) during the period from September of 1999 to August of 2002 were added in this study and long-term follow up was performed in 11 cases for 1 to 2 years after operation with insensate and stellate shaped flaps. Extensive digital artery dissections were performed in 9 fingers. Survival of the flaps and postoperative sensory recovery was successful in all 28 fingers. The static two-point discrimination ranged from 8mm to 4mm, with an average of 6.6mm. No patient showed severe discomfort for their sensory perception and, was required an additional operation for further improvement of the finger shape. We still think that the reverse digital artery island flap is an excellent choice for coverage of fingertip defects and are convinced that a couple of technical changes in this study contribute to the improvement of the procedure and its final outcome.
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