Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
