Shepard G H
J Hand Surg Am. 1983 May;8(3):254-9. doi: 10.1016/s0363-5023(83)80153-1.
An operation is described that is based on anatomical studies showing the pattern of the fibrous septa and neurovascular bundles of the distal phalanx. Lateral V-Y advancement flaps are outlined with the dorsal incisions going sharply to the bone. With palmar retraction of each flap, dense fibrous bands on its underside are sharply divided. The palmar incision is made through skin only. The nerves, vessels, and adipose tissue of this pedicle are preserved while the fibrous septa are carefully divided. This technique permits 10 to 14 mm advancement of each flap. Complete division of the dorsal pedicle permits great mobility of the flap without functionally diminishing circulation or innervation. This procedure is particularly useful in traumatic fingertip amputations with the palmar and transverse oblique deformities. Elective remodeling of irregular fingertips has also been aided by this operation.
