The finger or thumb tip was used as a homodigital neurovascular island flap ('top-hat flap') to reconstruct 28 segmental defects of the distal phalanx, nailbed or pulp over a 7-year period with a minimum follow-up of 12 months. All flaps survived and all fractures united. 75% of patients achieved full range-of-motion at the distal interphalangeal joint, 71% achieved 2-point discrimination <6mm and 92% returned to their preinjury unrestricted job less than 3 months after injury. The average digit AMA5 impairment score was 19%. The top-hat flap is an option for the treatment of complex injuries of the finger or thumb tip where there is a segmental defect in the nailbed, distal phalanx or pulp and a neurovascularly intact finger or thumb tip.
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