Since the first description of the cross-finger flap in 1950 for finger injury defect cover, over the last 70 years it has been tremendously explored and has underwent innumerable refinements and modifications. Whether used alone or in combination with other flaps for the reconstruction of finger defects, traumatic or non-traumatic, cross finger flap has proven its worth as a workhorse for finger reconstruction. Despite a handful of innate disadvantages, it has given excellent sensory, functional, and aesthetic outcomes in vast majority of studies. This article has been an attempt to reveal the entire rich journey and inexhaustible history of cross finger flap. With such a grandiose potential, it only seems that the cross finger flap will be continuously evolving over time and keep serving mankind in better ways.

Background Defining cut-off values of flap glucose levels in diagnosing free flap vascular compromise, without taking patients' glucose levels into account, does not hold good in all circumstances, especially in cases of high fluctuations in patients' capillary blood glucose and in diabetic patients. The aim of our study was to establish the role of capillary blood glucose measurements of the flap in relation to patients' fingertip, as an objective tool for postoperative free flap monitoring. Methods A total of 76 free flaps underwent postoperative monitoring with reference test (clinical parameters) and simultaneously with our index test (difference between capillary blood glucose of free flap and the patient), in non-diabetic and diabetic patients. Patients' demography and flap characteristics were also recorded. An ROC curve was plotted to determine diagnostic accuracy and cut-offs of the index test in diagnosing free flap vascular compromise. Results Our Index test has a cut-off value of 24.5 mg/dL with 68.75% sensitivity and 93% specificity, with an accuracy of 91.54%. Conclusion The difference between capillary blood glucose of free flap and the patient is simple, feasible, and inexpensive, and can be done by any health care professional and does not require any specialized facilities or training. It has an excellent diagnostic accuracy to detect impending free flap vascular compromise, especially in non-diabetics. Although in diabetics, this test becomes less accurate. Being an observer-independent objective test, the difference in capillary blood glucose of patient and flap measurement can be used as a highly reliable tool for postoperative free flap monitoring.

In this report, we discuss the excision of a large congenital nevus covering the nose and face and the reconstruction of the defect using an expanded forehead flap, in a 24-year-old man. We observed that after incorporating specific modifications including tissue expansion, thinning of the distal part of the flap, and placing the pedicle over the cutaneous branch of the supratrochlear artery, we were able to provide excellent aesthetic results using this time-tested paramedian forehead flap for nasal reconstruction. After we inset the flap, there was negligible donor site morbidity during a 33-month follow-up period.

Background: The standard (dorsal) cross-finger flap (CFF) is one of the common flaps used for fingertip reconstruction. There is little consensus regarding the sensory outcomes associated with this flap. In this systematic review, we evaluated objective sensory outcome parameters of patients who underwent CFF reconstruction. Methods: This systematic review is reported using the PRISMA protocol and was registered with the International Prospective Register of Systematic Reviews. Literature search was done using the terms ‘cross-finger flap’, ‘heterodigital’, ‘finger-tip’ and ‘transdigital’. Data regarding the number of patients, follow-up duration and sensory outcomes, including 2-point discrimination (2-PD) were extracted from included studies. The analysis was performed using Microsoft Excel with MetaXL add-in software. Certainty assessment and summary of findings table was created using GRADEpro GDT. Results: This review includes 14 studies with 301 patients. We found a statistically significant difference in static 2-PD of recipient and control fingers (pooled weighted mean difference [WMD]: 1.66; 95%CI: 0.03, 3.29; p = 0.00; I2=92%, n = 7 studies). Conclusions: Dorsal CFF reconstruction for fingertip defect does not provide adequate sensory recovery. Level of Evidence: Level III (Therapeutic)

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