Background: The retrograde homodigital island flap is a reliable and predictable option for reconstructing fingertip defects. It can be used to cover extensive soft tissue and bone defects and has a reported 98% survival rate with favorable functional outcomes. It does not require interphalangeal joint flexion and can incorporate a nerve for improved sensory outcomes.
Objectives: The present study aims to evaluate its effectiveness in terms of flap survival and sensory outcomes.
Patients and methods: This was a prospective interventional study conducted on 10 patients who admitted to Plastic Surgery Department in Qena University Hospital, and presented with fingertip injury and underwent reconstruction by reversed flow homodigital island flap from April 2022 to January 2023.
Results:  Total flap loss was observed in 2 (20%) of cases, while partial flap necrosis was observed in 2 (20%) of cases which healed with conservative wound management. Two patients (20%) exhibited contracture and decreased joint mobility. Cold intolerance and hypersensitivity substantially reduced over the follow-up period. Abnormal Semmes-Weinstein tests was not observed after 3 months postoperatively till end of follow up period. Two -point discrimination has improved significantly.
Conclusion:  Although reversed flow homodigital artery flap is a reliable method for fingertip reconstruction, we experienced a relatively high rate of flap loss, which may be related to smoking in our study group. Nevertheless this technique improves cold intolerance, hypersensitivity, and two-point discrimination. It benefits patients with extensive tissue damage, and bone or joint involvement, greatly enhancing their quality of life and functional abilities.