Distal fingertip amputation stumps with exposed bone can often be treated by local advancement flaps such as the volar V-Y advancement flap and Kutler lateral V-Y advancement flaps with preservation of length and provision of "like" glabrous skin. When there is exposed distal phalanx and insufficient soft tissue for coverage of a volar oblique amputation, various cross-finger flaps or thenar flaps may be employed.

Problems with cross-finger flaps are potential donor site morbidity related to the need for a skin graft over the dorsal aspect of the adjacent digit and very conspicuous hyperpigmentation of this skin-grafted site in dark-skinned patients. The classic thenar flap places a scar on the thenar region potentially jeopardizing the motor branch of the median nerve, requires marked flexion of the injured finger, and occasionally requires a skin graft. A modification of the classic thenar flap, described by Russell et al. in 1981, is the thumb metacarpophalangeal joint flexion crease flap. The MCPJ flexion crease flap allows the donor site to be closed primarily by gently flexing the thumb thus avoiding a skin graft or palmar scar, requires less flexion than the standard thenar flap, and is well tolerated in children and adults. It can be based radially, ulnarly or in H-shaped fashion.

This poster will illustrate the author's experience with 12 MCP flexion crease flaps. It will describe the role of this versatile flap in reconstruction of fingertip amputations and discuss its significant advantages over the classic thenar flap and cross-finger flaps.