Reverse adipofascial flap. A, Z incision. B, Instead of Z incision, quadrangular incision is marked on dorsum of finger as alternative, leaving 5 mm as basis of flap just proximal to germinal matrix. a = defect + germinal matrix; flap length = a + 5 mm to cover the basis. C, Skin flaps are raised, leaving paratenon intact, and adipofascial flap is raised from proximal to distal until marked basis is reached. D, Adipofascial flap is turned over to defect, and skin flaps are sutured to remain open above base of flap. Split-thickness skin graft (SSG) is ready to be applied.