This case involved the traumatic amputation of the whole middle phalanx, the proximal two-thirds of the distal phalanx, and the dorsal skin of the affected digit, which are very rare injuries. Although several reconstructive options were available in the present case, we reconstructed the whole middle phalanx in addition to the proximal interphalangeal ( PIP ) joint using a free costal osteochondral graft wrapped in a corticoperiosteal flap from the medial condyle of the femur. The dorsal skin defect was covered by placing a skin graft on the vascularized periosteum. The corticoperiosteal flap and skin graft survived without any problems. The part of the free costal graft that was wrapped in the corticoperiosteal flap was gradually remodeled, although the unwrapped region was gradually absorbed. The corticoperiosteal graft from the femur prevented the free costal bone from undergoing atrophication and absorption. Although we performed a joint mobilization operation for the PIP joint and flexor tenolysis, a sufficient active range of motion could not be achieved in the PIP joint due to the lack of an A2 pulley.
