Distal Phalanx Reconstruction with Bone Graft and SCIP Flap-Case Report

ABSTRACT
The distal phalanx plays a crucial role in gripping and grasping functions of the finger. Injuries, particularly those requiring distal phalanx repair, can be challenging. Four main factors to consider in this repair are: bone reconstruction, wound closure, aesthetic concerns during wound closure, and restoring finger movement. This report presents a case involving an amputation defect in the 2nd finger of the left hand due to a power saw injury. The injury resulted in an oblique amputation defect extending from the middle phalanx to the distal phalanx. While there was a soft tissue defect in the middle phalanx, the distal phalanx only included the nail. In the repair process, a 1.5 cm long partial bone graft taken from the middle phalanx was fixed with microplates and screws. The flexor tendon was sutured to the end of the distal screw. After debridement of the finger edges, a 3x4.5 cm defect was created. This defect was covered with a 3.5x6.5 cm thin SCIP flap taken from the left inguinal region. The flap was anastomosed end-to-side to the radial digital artery and end-to-end to the concomitant vein. The patient was discharged after a one-week follow-up. Subsequent follow-ups showed thinning of the flap and restoration of finger mobility. Using a partial bone graft from the phalanx, performing tendon repair, and applying a free flap helped preserve the dorsal anatomy of the hand, unlike other regional flap options. However, the length of the surgery, extended hospital stay, and high cost are disadvantages of this method.
Keywords: SCIP flap,distal phalanx,finger,Reconstruction,Bone graft