In this week's edition
- ✍️ Letter from P'Fella
Your chance to request new platform features - 🖼️ Image of the Week
FDMA flap: Sensate thumb reconstruction - 🚑 Technique Tip
Fingertip replantation: Single artery + vein graft strategy - 📖 What Does the Evidence Say?
Choose the local flap by defect geometry, not by habit - 🎈 Upcoming Events
Launching Grassroots in Malaysia! - 🔥 Articles of the Week
Dorsal metacarpal artery flap, V-Y rotation advancement flap, & an overview of local hand flaps - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Your Chance to Request New Platform Features
So we've been carefully considering what actually needs building next. What would genuinely make the site more useful for the people who come back to it every week?
When something is still small, you can keep adding pages and resources and hope it all sorts itself out. But once you start building something thousands of people are going to use daily, again and again, you have to make very informed decisions. What should be easier to find? What should work faster? What would actually help someone when they’re revising, teaching, on call, or trying to think through a case the night before theatre?
That’s the bit we’ve been paying extra attention to. It includes everything: how it should look, how it should feel, what it should actually do. There are loads of things we could try and build next. Operative walkthroughs, more revision tools, decision-making aids, the list goes on.
While none of those are bad ideas, we just don’t want to sit in a room and decide for everyone else what matters most.
So this week, we wanted to ask you something simple. What tool would actually help you most right now? What would make your life easier in an instance?
This’ll help us decide what gets prioritised as we shape the next version of the site. If there’s something you keep wishing The Plastics Fella could do better, or something you’ve wanted us to build for a while, this is the best time to tell us.
With love,
P’Fella ❤️
ps - completely rebuilt platform is coming soon 🔥
Image of the Week
FDMA Flap: Sensate Thumb Reconstruction
This image demonstrates an innervated first dorsal metacarpal artery (FDMA) island flap for reconstruction of a thumb pulp defect with exposed bone.
The flap is raised from the dorsum of the index finger, based on the FDMA, and transferred as an island flap to the thumb. Incorporation of a sensory branch of the superficial radial nerve (arrow) allows restoration of protective sensation, a key requirement for thumb function.
Postoperative images show good contour, coverage, and functional recovery, with the donor site managed using a full-thickness skin graft.
The FDMA flap remains a reliable local option for thumb defects, combining vascular reliability with sensory restoration.
Technique Tip
Fingertip Replantation: Single Artery + Vein Graft Strategy
This video shows Tamai Zone I fingertip replantation, highlighting a key principle: arterial inflow is prioritised, even when venous outflow is limited. In distal amputations, suitable veins are often absent, making artery-only or artery + vein graft techniques essential salvage strategies.
The technique shows meticulous identification of proximal and distal vessels, followed by interposition vein grafting (from the thenar) to bridge arterial gaps. Critical steps include atraumatic handling, precise supermicrosurgical anastomosis, and intraoperative patency checks (bleeding/refill).
What Does the Evidence Say?
Choose the Local Flap by Defect Geometry, Not by Habit
It goes without saying that one flap does not fit every fingertip. For oblique lateral or volar losses, the literature repeatedly points to the oblique triangular (Venkataswami) flap as a better geometry-matched option because it can preserve digit length and provide sensate coverage when simple straight advancement may not reach; on the thumb, the same principle underpins the continued role of the Moberg flap for palmar thumb-tip defects.
Sources: (Rehim, 2014); (Chakraborty, 2021); (Venkataswami, 1980); (Elsewify, 2023)
Upcoming Events
Launching Grassroots in Malaysia!
📍 Malaysia | 📅 2 May 2026 | ⏰ 8:30 AM - 1:00 PM
Led by Dr Mohd Shahrul (Plastic, Burn & Reconstructive Surgeon; MSBI President), this session explores practical burn assessment, resuscitation, and early surgical decision-making, using real clinical scenarios to move beyond generalised formulas.
What to expect:
- Pre-reading to guide learning
- Small-group, case-based teaching
- Early exposure to surgical thinking in burns
- Grassroots merch
🎟️ Limited spots available, register below.
Articles of the Week
3 Interesting Articles with One-Sentence Summaries
The FDMA is consistently present with predictable radial, ulnar, and intermediate branches, plus a cutaneous branch accompanying the radial nerve, providing a dependable vascular basis for sensate flaps covering thumb and dorsal hand defects up to the PIP joint.
A bilateral V-Y rotation advancement flap enables reliable, sensate fingertip reconstruction without donor morbidity, achieving 100% flap survival, preserved sensation, and early return to work by combining advancement with rotation to increase tissue reach while maintaining the neurovascular bundle.
Local hand flaps provide reliable, well-vascularised soft tissue coverage using adjacent tissue, allowing preservation of sensation, contour, and function while avoiding the morbidity of distant or free flaps; selection is guided primarily by defect characteristics and regional vascular anatomy.
