Fingertip Reconstruction With Homodigital Adipofascial Reverse Flap Versus Dermal Substitute: A Comparative Retrospective Study.

BACKGROUND: Fingertip injuries frequently involve exposure of bone, tendon, or nail bed and require reconstruction to restore function and appearance. The homodigital adipofascial reverse flap (HDARF) and bilayer dermal substitutes such as Integra are commonly employed, but few comparative studies exist. METHODS: A retrospective monocentric study was conducted, including 40 patients treated between 2012 and 2024 for traumatic pulp loss: 20 with HDARF and 20 with dermal substitute plus skin graft. Outcomes were assessed using Semmes-Weinstein monofilament (SWM) test, 2-point discrimination (2PD), Cold Intolerance Symptom Severity, Michigan Hand Outcomes Questionnaire, and return-to-work time. RESULTS: All patients achieved wound healing without major complications. Homodigital adipofascial reverse flap provided superior sensory recovery (85% with normal SWM; mean 2PD < 5 mm), lower incidence of cold intolerance and nail deformities, and shorter return-to-work intervals. Dermal substitutes required longer healing but yielded good aesthetic outcomes and preserved donor sites. CONCLUSIONS: Both HDARF and dermal substitutes are safe and effective options for fingertip reconstruction. Homodigital adipofascial reverse flap is preferable for young, active patients requiring rapid functional recovery, whereas dermal substitutes represent a valuable alternative when minimal invasiveness and donor-site preservation are prioritized.