Introduction: Fingertip amputations, often resulting from crush mechanisms, pose significant challenges in microvascular replantation. Operative managementis often necessary for larger defects, bone exposure, and associated distal phalangeal fractures. Treatment goals include preserving length, sensation, and aesthetics. Various techniques such as revision amputation, composite grafting, and local flaps are available but usually have limitations. We introduce a novel homodigital flap technique named ‘Colombo flap’ addressing these limitations.

Methods: The study was done in a major trauma centre, The National Hospital of Sri Lanka. Five fingertip injuries in four patients were treated using the new technique. Recruited patients had traumatic proximal Allen zone 3 fingertip amputations with minimal residual nail bed, secondary to crushed mechanisms which were unsuitable for microvascular replantation. Surgical technique involved meticulous debridement, raising of a uni-pedicled islanded flap including the total pulp, and inset of the flap with advancement. Postoperative care comprised of antibiotic therapy, elevation, and scar management. Participants were followed up for 2.5 years, assessing sensory recovery, range of motion, grip strength, pain, and outcomes using standardized measures including Michigan Hand Questionnaire.

Results: All flaps survived without complications, and donor sites healed well with no flexion contracture. Minimal hook nail deformity was noted (Lim grade 1–2). Patients returned to work within 3–4 weeks. There were no pain or cold intolerance during the follow up. Sensory recovery was satisfactory (S3+/S4), grip strength was comparable to uninjured hand, and MHQ scores averaged 97.6%, indicating highly successful outcomes.

Discussion and Conclusion: The ‘Colombo flap’ represents a reliable technique for fingertip reconstruction, offering satisfactory short- and long-term outcomes. Its success suggests it as a valuable addition to the armamentarium of fifingertip reconstruction techniques. Further studies are warranted to validate its efficacy and explore its potential applications.

Dr. Jeewan Pradeep Rankothkumbura, is a Consultant (Acting) Plastic Surgeon from Sri Lanka and a Plastic Surgery Clinical and Research Fellow at The Canberra Hospital, Australia. With over a decade of surgical experience, he specializes in plastic, reconstructive, and hand surgery, with expertise in microsurgery, burns management, and general plastic surgery. Dr. Rankothkumbura obtained his MBBS with First Class Honours from the University of Peradeniya, ranking second in the national merit list in 2013. He further specialized with an MD in Surgery from the University of Colombo and an MRCS from the University of Glasgow. His career spans multiple high-volume surgical centers in Sri Lanka and Australia, where he has been actively involved in complex hand and general plastic surgical procedures, patient care, and medical education. In addition to his clinical work, he is dedicated to research and has authored multiple peer-reviewed publications. His contributions to surgical innovation and education have been recognized with several awards, including the prestigious Dr. P. R. Anthonis Gold Medal in Surgery. Committed to advancing plastic surgery, he continues to integrate research, education, and clinical excellence to improve patient outcomes.