ePlasty: Vol. 20
Modified Littler Flap Reconstruction of the Small Finger
Rebecca C. O'Neill, BS, Ronald N. Bogdasarian, MD, and Ramazi O. Datiashvili, MD, PhD

Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark

Key words: Littler flap, small finger defects, thumb pulp defects, sensation restoration, hand reconstruction


A 43-year-old, right-hand-dominant male truck driver presented after a low-voltage electrical burn to the right hand, resulting in a 2 × 2-cm open wound at the volar aspect of the proximal phalanx of the small finger with exposed tendon.


1. What is the Littler flap?

2. What are the outcomes of Littler flap reconstruction?

3. What are the disadvantages of the Littler flap?

4. What modifications have been made over time to this technique?


The hand's dexterity and sensory capacity endow humans with a powerful tool to manipulate the environment. There are a myriad of techniques to reconstruct open wounds of the hand. The Littler flap is a neurovascular island flap, originally described to reconstruct the open wound and restore sensation of the pulp following traumatic injury to the thumb.1 The dono .......