Free toe pulp flap for finger pulp and volar defect reconstruction

ABSTRACT

Background: Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement. Materials and Methods: From June 2015 to April 2016, we performed seven free toe pulp flaps for finger defect reconstruction. All patients were males. Five flaps were done in emergency post-traumatic cases, and two were done in elective set up. The cases included reconstruction of three thumbs, one index and one ring finger in an emergency set up and two ring fingers in the elective. Thumb reconstruction was done with great toe lateral pulp and the other digits reconstructed with second toe pulp flap. Follow-up evaluation included both functional and aesthetic assessment. Results: Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4–8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm²). Three patients had delayed donor site wound healing. Conclusions: The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match.

KEY WORDS

Finger defect - free toe pulp flap - pulp defect - reconstruction - volar defect

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Papatheodorou LK, Dailiana ZH, Varitimidi SE, Hantes ME, Basdekis GK, Malizos KN. Digital coverage with flaps from the same or neighboring digits. Hippokratia 2011; 15: 153-6
• 2 Yan H, Ouyang Y, Chi Z, Gao W, Zhang F, Fan C. Digital pulp reconstruction with free neurovascular toe flaps. Aesthetic Plast Surg 2012; 36: 1186-93
• 3 Wang ZT, Sun WH. Cosmetic reconstruction of the digits in the hand by composite tissue grafting. Clin Plast Surg 2014; 41: 407-27
• 4 Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: The cross finger flap revisited: Indications, technical refinements, outcomes and long term neurosensory recovery. Ann Plast Surg 2008; 61: 385-91
• 5 Flatt AE. The thenar flap. J Bone Joint Surg Br 1957; 39B: 80-5
• 6 Komatsu S, Tamai S. Successful replantation of a completely cut off thumb. Plast Reconstr Surg 1968; 42: 374-7
• 7 Wang H, Chen C, Li J, Yang X, Zhang H, Wang Z. Modified first dorsal metacarpal Island flap for sensory reconstruction of thumb pulp defects. J Hand Surg Eur 2016; 41: 177-84
• 8 Lee NH, Pae WS, Roh SG, Oh KJ, Bae CS, Yang KM. Innervated cross-finger pulp flap for reconstruction of the fingertip. Arch Plast Surg 2012; 39: 637-42
• 9 Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K. et al. Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 2006; 118: 1579-84
• 10 Yoon ES, Kim DW, Chun D, Dhong ES, Koo SH, Park SH. et al. An anatomic study and clinical application of medial pedis flap in Asians. Ann Plast Surg 2007; 58: 517-22
• 11 Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am 1980; 5: 575-83
• 12 Morrison WA, O’Brien B. Surgical opportunism in emergency hand surgery. World J Surg 1991; 15: 439-45
• 13 Morrison WA. Microvascular nail transfer. Hand Clin 1990; 6: 69-76
• 14 Morrison WA, O’Brien BM, MacLeod AM. Experience with thumb reconstruction. J Hand Surg Br 1984; 9: 223-33
• 15 Morrison WA, MacLeod AM, O’Brien BM. Digital reconstruction in the mutilated hand. Ann Plast Surg 1982; 9: 392-9
• 16 Lee DC, Kim JS, Ki SH, Roh SY, Yang JW, Chung KC. Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg 2008; 121: 899-907
• 17 Zheng H, Liu J, Dai X, Machens HG, Schilling AF. Free lateral great toe flap for the reconstruction of finger pulp defects. J Reconstr Microsurg 2015; 31: 277-82
• 18 Yoon WY, Lee BI. Fingertip reconstruction using free toe tissue transfer without venous anastomosis. Arch Plast Surg 2012; 39: 546-50
• 19 Koshima I, Inagawa K, Urushibara K, Okumoto K, Moriguchi T. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000; 105: 1666-74
• 20 Cho YJ, Roh SY, Kim JS, Lee DC, Yang JW. Second toe plantar free flap for volar tissue defects of the fingers. Arch Plast Surg 2013; 40: 226-31
• 21 Lin CH, Lin YT, Sassu P, Lin CH, Wei FC. Functional assessment of the reconstructed fingertips after free toe pulp transfer. Plast Reconstr Surg 2007; 120: 1315-21