title: Fenestrated Adipofascial Reverse Flap: A Modified Technique for the Reconstruction of Fingertip Amputations.
abstract: OBJECTIVE
  Fingertip injuries can be treated in different ways, including shortening with primary closure, skin graft, and local or distant flaps. Several local flaps for the reconstruction of the amputated fingertip were described. We present our experience with a new concept of homodigital adipofascial reverse flap that avoids the second surgical stage and allows a complete and anatomically perfect reconstruction of nail bed, with preservation of the nail lamina.
  
  
  METHODS
  Between March 2014 and February 2015, five patients with digital amputations (distally to the nail matrix) were treated using the Fenestrated Adipofascial Reverse (F.A.R.) flap. The patients were evaluated measuring 2-point discrimination (2PD) value and range of motion of the distal interphalangeal joint (DIP). Scar evaluation was performed using the Vancouver Scar Scale (VSS).
  
  
  RESULTS
  All the flaps completely survived. A normal nail grow has been observed in first two-three months of post operatory follow-up. Length of the digits was preserved and good aesthetic as functional outcome were archive. The F.A.R. flap provided excellent coverage of fingertip defects and preserved finger length. After 1 year of follow, the mean static 2PD value at the reconstructed finger was 4.2 mm (range 3-5 mm), reconstructed fingers' mean range of motion for the DIP joint was 78 degrees and the VSS score ranged from 0 to 2 (mean score: 0.6). No complications were reported.
  
  
  CONCLUSIONS
  F.A.R. flap is one of the most useful techniques in order to achieve all the goals in fingertip reconstruction.
authors.affiliation: a Jalisco Plastic and Reconstructive Institute, University of Guadalajara , Guadalajara , México.
authors.forename: Francesco
authors.initials: F
authors.lastname: Idone
authors.affiliation: b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sisti
authors.affiliation: b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy.
authors.forename: Juri
authors.initials: J
authors.lastname: Tassinari
authors.affiliation: b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nisi
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000009:adverse effects / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: adipofascial reverse flap; fingertip amputation; fingertip reconstruction; nail trauma