Aesthetic and sensory reconstruction of finger pulp defects using free toe flaps

This study illustrates aesthetic and sensory reconstruction of finger pulp defects with free toe flaps from the lateral aspect of the great toe or the medial aspect of the second toe.

Between August 2007 and July 2010, free toe flaps were harvested and used for 21 fingers of 21 patients. The average patient age was 34.5 years (range 19-62 years). The soft tissue defects were found in the thumb of 6 patients, the index finger of 7 patients, the middle finger of 5 patients, and the ring finger of 3 patients. The donor site was the great toe for 9 patients and the second toe for 12 patients. The average flap size was 2.8 × 2.0 cm (range 1.7 × 1.7 to 3.5 × 3.0 cm). Restoration of the sensitivity, aesthetic appearance, and mobility of the injured fingers compared with the opposite side was assessed using appropriate tools during the follow-up time.

All the flaps in this series survived completely, with a high survival rate of 100 %. No urgent operative revision necessitated by postoperative thrombosis of the vessels was performed during the follow-up period. During a mean follow-up period of 18.4 months (range 12-24 months), the average static two-point discrimination score for the injured finger pulp was 4.8 mm (range 3-7 mm), and the Michigan Hand Outcome Questionnaire score was 4.9 mm. The mean range of motion of the distal interphalangeal joint in the injured finger was 69.7°.

Transplantation of free microvascular flaps from the great toe or the second toe is a useful and reliable technique for finger pulp defect reconstruction.

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