title: Extended step-advancement flap for avulsed amputated fingertip--a new technique to preserve finger length: case series.
abstract: OBJECTIVE
  The conventional step-advancement flap does not restore fingertip length after avulsion amputation with projecting bone owing to the limited size of the distal triangular flap. To overcome this problem, the extended step advancement flap using the stepladder principle, described in this article, provides an extended distal triangular flap that can be wrapped around the projecting tip of the distal phalanx while avoiding longitudinal volar scarring. The purposes of this study were to present a modification of the original step-advancement technique and to report on results in 6 patients.
  
  
  METHODS
  Between 2007 and 2009, 6 men (mean age, 29 y; range, 18-45 y) presented with a large projecting tip of exposed bone of the distal phalanx after avulsion injury. All 6 had reconstruction using the described technique. After surgery, the finger was immobilized with a splint, followed by rehabilitation. During the follow-up of 9 to 12 months, we clinically assessed flap-site skin quality, scar contractures, and finger mobility. We measured the finger's range of motion with a goniometer. Sensibility was evaluated using the static 2-point discrimination test.
  
  
  RESULTS
  The postoperative course was uneventful. All flaps survived completely, except one that had mild marginal necrosis. We observed near-total active range of motion in all patients. The average static 2-point discrimination was 4 mm with a range of 3 to 5 mm. All patients resumed normal daily activities after 8 weeks.
  
  
  CONCLUSIONS
  The extended step-advancement flap is ideal for closure of challenging fingertip amputation wounds because it maintains length and minimizes scars while providing a well-padded, sensate tip. It is a viable alternative to replantation of the fingertip.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Plastic Surgery, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Atalla A
authors.initials: AA
authors.lastname: Hammouda
authors.forename: Hamdy A
authors.initials: HA
authors.lastname: El-Khatib
authors.forename: Talal
authors.initials: T
authors.lastname: Al-Hetmi
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult