A Dual-Pivot Point Technique

Background: To investigate the surgical technique and clinical outcomes of using a proper digital artery perforator flap with double-pivot points for the reconstruction of a fingertip defect. Methods: From January 2023 to January 2024, a total of 11 patients with distal finger defects underwent reconstruction using a double-pivot proper digital artery perforator flap based on the dorsal branch at the middle phalanx of the proper digital artery. The flap was designed on the dorsal aspect of the middle phalanx. By incorporating the perforator vessel and a segment of the proximal proper digital artery trunk, a vascular pedicle with double pivot points was created. Functional and aesthetic assessments were performed postoperatively. Results: The mean follow-up time was 10.8 months (range: 6 to 15 mo). All patients achieved primary wound healing without complications such as infection or vascular compromise. Mean DIP motion was 49.5 degrees (range: 40 to 60 degrees), and mean PIP motion was 97.7 degrees (range: 80 to 110 degrees). Average s2-PD on the pulp was 7.0 mm (range: 5 to 10 mm). The mean MHQ score for aesthetic satisfaction was 4.6 (range: 4 to 5). According to the VAS, the mean pain score was 0.5 (range: 0 to 2). A total of 8 patients reported no cold intolerance, and 3 reported mild cold intolerance (mean CISS 4.1). The mean duration of return to work was 9.7 weeks (range: 6 to 15 wk). All patients reported satisfaction with the final outcomes. Conclusion: The double-pivot proper digital artery perforator flap is an effective technique for functional fingertip reconstruction, combining reliable vascularity, extensive reach, and relative technical simplicity.