Functional assessment of the reconstructed fingertips after free toe pulp transfer

Posttraumatic fingertip reconstruction with free toe pulp transfer was first described in 1979. Several studies have tested the sensibility of the reconstructed digits using the two-point discrimination test. The goal of this study was to comprehensively assess the functional outcome of the reconstructed fingertips after free toe pulp transfer.

There were 15 flaps in 14 male patients in this retrospective study. Objective sensory recovery was assessed with two-point discrimination and Semmes-Weinstein monofilament tests. Pinch power of the reconstructed digits and subjective pain and discomfort were also evaluated.

Six flaps had good results, six had fair results, and three could perceive only one point. The Semmes-Weinstein monofilament test revealed diminished light touch in six flaps, diminished protective sensation in eight flaps, and loss of protective sensation in one flap. There was strong correlation between static and moving two-point discrimination (gamma = 0.78747, p = 0.0005) but weak correlation between static two-point discrimination and the Semmes-Weinstein monofilament test (gamma = 0.34240, p = 0.2116). There was a significant difference in static two-point discrimination (p < 0.01) but no significant difference in Semmes-Weinstein results between the contralateral toes and flaps. The mean difference in pinch power between the dominant and nondominant hands was 6.72 percent with involvement of the dominant hand and 34.16 percent with involvement of the nondominant hand. There was no significant difference between the pinch power of the reconstructed digits and adjusted values.

After free toe pulp transfer, the reconstructed digits had equal sensory threshold as the donor toes, but functional sensibility varied. Pinch power was restored. Free toe pulp transfer restored the sensibility, stability, and durability of the finger pulp and achieved functional recovery of the traumatized digits.