Fingertip reconstruction must be carried out from the standpoint of function as well as cosmesis. In order to maintain the length of the finger, the flap must be carefully selected and applied depending on the size, shape and the location of the defect. There are several options for optimum flap selection. In this report, our surgical methods are demonstrated and we discuss such clinical issues as the indication and limit of the flaps often introduced for the fingertip reconstruction. Oblique triangular flap and reverse vascular pedicle digital island flap were the flaps most frequently used for our fingertip reconstructions. Wrap-around flap was specifically indicated for reconstruction of the nail. Fingertip reconstruction was previously planned based upon the order of “reconstruction ladder”. In fingertip reconstruction, it is also necessary to be familiar with local flaps. With recent technical advancements in microsurgery, reconstruction procedures have become less invasive with minimal sacrifice of the donor site. The concept of the “reconstructive elevator” using recent microsurgical innovation is beginning to make it possible to repair the fingertip with wider options of flaps in a less invasive and more tailored manner.
