Abstract
BACKGROUND: Fingertip and nail bed injuries represent complex reconstructive challenges in hand surgery, requiring restoration of both function and aesthetics. The nail unit's intricate anatomy-comprising the matrix, bed, and surrounding tissues-necessitates precise surgical techniques to prevent long-term deformities and sensory deficits. This study presents and evaluates the "clover flap," a novel homodigital advancement technique designed for dorsal fingertip injuries involving partial or complete nail bed loss. METHODS: In this retrospective cohort study, 63 patients with dorsal fingertip defects were treated between 2005 and 2023 using the clover flap at a primary referral center. The flap involves volar V-Y advancements redirected dorsally in a trifoliate configuration, allowing one-stage coverage without grafts. Outcomes were assessed using standardized clinical, functional, and aesthetic metrics including Quick-DASH, 2PD, POSAS, FIOS, and OFNAS scores. RESULTS: No complete flap necrosis occurred. Nail deformities were limited to 17.5 % of cases, with minimal donor site morbidity. Patients achieved a mean Quick-DASH score of 14.6, 2PD of 7.3 mm, and an active ROM of 224°. Grip and pinch strength recovered to 79 % and 81 % of the contralateral side, respectively. Aesthetic outcomes were favorable, with an OFNAS of 4.5 and FIOS of 11.3. Multivariate analysis confirmed functional and cosmetic stability over time, regardless of complication presence. CONCLUSION: The clover flap offers a reliable, one-stage reconstructive option for dorsal fingertip injuries, combining high functional recovery with excellent nail bed and scar aesthetics. Its design preserves nail matrix integrity, avoids microsurgery, and is particularly suitable in acute care settings.