Level of

A modification of the flap first described in 1935 by Tranquilli-Leali and escribed again by Atasoy et al (1970) is presented. The relative indications for use of the original and the modified flap are examined in the fight of our experience of 116 flaps over a period of 4 years. Journal of Hand Surgery (British and European Volume, 1995) 20B. " 6. " 815-823 The flap described by Tranquilli-Leali in 1935, described again by Atasoy et al (1970), and translated into English more recently (Lister, 1991) is an advancement of palmar skin and pulp tissue to cover exposed bone at the digital tip. Because the flap is vascularized by the small vessels of the subcutaneous pulp tissue lateral to its edges and distal to the trifurcation of the digital arteries, its use must be limited to amputations distal to the nail fold (Ishikawa Classification Types 1 and 2) (Fig 1; Ishikawa et al, 1990). Lister also pointed out that it can only provide adequate bone cover if the amputation is transverse or dorsal-facing (Lister, 1984). We have found use of this flap to be further estricted in that it is only adequate for transverse amputations at or distal to the mid-nail level (Ishikawa Type 1). Proximal to this level, the flap bulk is too small and does not advance far enough to provide good tip cover, except in those transverse amputations just distal to the nail fold, which can be converted to dorsal-facing ampu