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Workhorse flaps for distal digital reconstruction: an algorithmic approach to surgical decision-making

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Owing to its intricate structural and functional anatomy, the fingertip is immensely critical for a wide range of functions like sensation, gripping and fine handling. Therefore, it is important to be familiar with such injuries and their available treatment plans to ensure satisfactory aesthetic and functional results. We present our experience on fingertip reconstruction along with a critical analysis of the employed reconstructive techniques, their outcomes and an algorithm-based approach to address fingertip injuries.


A retrospective chart review of all fingertip injuries presented to the Sawai Man Singh Hospital was conducted during September 2018 and September 2020. Data on the defects size, type of reconstructive technique employed, surgical outcomes and surgical complications was recorded and analyzed.


This study included 92 fingertip injuries in 80 participants, 22 injured thumbs, 21 injured index fingers, 24 injured middle fingers, 20 injured ring fingers and 5 injured little fingers were reported. The most common mechanism of injury was machine injury (n = 58, 72.5%) and electric burn (n = 12, 15%). The most common surgical techniques were the V–Y advancement flap (n = 30), Moberg flap (n = 10), reverse homodigital island flap (n = 8) and first dorsal metacarpal artery flap (n = 8). The average size of soft tissue defect was 2.1 cm.


Adequate knowledge of the anatomical structures, a satisfactory analysis of the type and mechanism of injury aid in the selection of reconstructive alternatives for fingertip injury, which, in turn, prevents secondary deformities, improves functional outcomes and decreases secondary reconstructive procedures that are more complicated and have unpredictable results.

Level of evidence: Level IV, therapeutic study.

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Correspondence to Samarth Gupta.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is a retrospective study. The institutional ethics committee has confirmed that no ethical approval is required.

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Gupta, S., Goil, P., Mohammad, A. et al. Workhorse flaps for distal digital reconstruction: an algorithmic approach to surgical decision-making. Eur J Plast Surg 45, 139–148 (2022).

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