Introduction: Injuries with defects of the distal phalanges can involve the dorsum, the tip and the pulp of the finger. If the amputate is replantable, replantation is the best surgical option. If replantation is not possible, the surgical options are different for the dorsum and the pulp, because the latter needs sensory reconstruction. Preservation of length should be achieved, we introduce the sensory crossfinger flap for the pulp and the free venous flap for the dorsum as alternatives for conventional procedures.

Patients and results: Pulp defects: Sensory reconstruction is achieved with a doubly innervated sensory crossfinger flap. We present a series of 15 patients, where a mean sensory two point discrimination of 4,3 mm was achieved with a low rate of complications. Dorsal defects: the free venous flap is an alternative for conventional homodigital and heterodigital flaps Defects of the tip: In seven cases of end phalangeal replantation, three of them children, a mean two point discrimination of 3,8 mm was achieved.

Discussion: The procedures are technically demanding, but provide good results with a low complication rate.