The cross-finger flap is an ideal flap for providing coverage over the volar aspect of the digits. In this case, a defect on the ring finger is covered with a flap from the middle finger. The dimensions of the flap are marked out carefully in order to ensure adequate coverage. The flap is sharply elevated. I try to make sure that I incorporate the dorsal veins with the flap and the peritoneum over the extensor tendon. This will ensure that the skin graft can take over the extensor tendon. The peritoneum is demonstrated here with the forceps. The dimensions of the skin grafts are then marked out for harvest from either the wrist or the hypothenar region of the hand. Elliptical incisions are marked out to facilitate wound coverage. The volar wrist incision has the downside of appearing to be a suicide incision. The hypothenar incision makes the ulnar border of the hand a little bit more sensitive to pressure. In this case, the hypothenar skin is harvested sharply. Once the skin graft is fully elevated, it will be thoroughly defatted to the limits of the dermis. The excess portions of the skin graft are trimmed and then the skin graft is defatted. Furthermore, we often perforate this with an 18-gauge needle to facilitate egress from blood from underneath the graft. Typically, the graft is inset with absorbable sutures as they can become incorporated as the graft heals. The flap is inset into place with non-absorbable sutures to make sure that the graft and flap are securely anchored to the recipient site. It's important to release the tourniquet to make sure the suture is not too tight and are compromising blood flow to the flap. The donor sites are closed and typically a bolster is sutured over the site of the skin graft to ensure take. The bolster is left on place for 10 days and the flap can then be divided 2-3 weeks later.

cross-finger flap technique

coverage

skin grafts

wound healing

flap