ABSTRACT

Dorsal Digital Wounds Occasionally there will be damage to the skin dorsal surface of individual digits. The practitioner should assess the extent of the wound, i.e. the size of the defect and the amount of tissue available for reconstruction. Depending on the size of the wound, the techniques to be used for reconstruction would be those described for wounds of the carpal-metacarpal/ tarsal-metatarsal areas or modifications thereof. Often wounds on the dorsum of the digits involve multiple digits. If there is sufficient interdigital skin remaining, its use in reconstructing the dorsal digital surfaces should be considered (Figure 4-3). If there is not sufficient interdigital skin, it will be necessary to consider a mesh graft or some form of flap for reconstructing the area. When interdigital skin is present in a small amount, it should be removed, thus making it like a paw where circumstances have resulted in loss of both dorsal paw and interdigital skin (Figure 4-4). This will allow the axial and abaxial surfaces of the involved adjacent digits to heal together (fuse) while the graft or flap on the dorsal surface of the digits heals in place. To enhance the fusion of the axial and abaxial digital surfaces interrupted absorbable sutures can be used judiciously to suture the digits together. However, care should be taken to try to avoid incorporating the

dorsal and palmar/plantar common digital vessels, or the axial and abaxial dorsal proper and palmar/plantar proper digital vessels in the sutures, thus ligating them. It is important not to place a graft over the dorsal surface of the digits, covering intact interdigital skin.