Modified mid palmar flap for middle finger tip injuries: A review of 12 cases

Background: Fingertip is the most commonly injured area of the hand. The two most commonly advocated flaps for fingertip reconstructions are cross finger flap and thenar flap. There is another flap, raised from the middle of the palm, midway between thenar and hypothenar eminence, called the mid palmar flap which never became popular because of inherent drawback of causing extensive joint contractures. To overcome the problem of joint contractures we added extra 5 mm to the length of flap and separated it by 14 days. Aims and Objectives: This study was conducted to review the outcome, in terms of joint contracture and scar aesthetics in middle finger tip injuries covered with modified Mid palmar flap. Material and Methods: The present study was done in the Department of Plastic Surgery, at Dayanand Medical College & Hospital, Ludhiana, Punjab. Various variables analysed were age, sex, mode of injury, hand dominance, associated fractures and exposed bone. All cases were done under local anaesthesia. Time to division ranged from 12- 14 days. Results: A total of 12 patients were included in this study. The mean age of patients was 35 years. The most common mode was accidental machine injury. The dominant hand (right) was injured in 5 patients. There was associated distal phalanx fracture in 5 patients. There was exposed bone in 7 patients. There was no reported case of hypertrophic scarring at donor site. Scar tenderness was there in 3 of the 12 patients and it persisted for maximum of 6 weeks. PIP and DIP joint stiffness was there for initial 10 days. Conclusion: For middle finger tip injuries, mid palmar flap, with modifications as described, could be better than thenar flap.