Third Toe Pulp Reconstruction Using the Contralateral Second Toe Hemi-pulp Free Flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Hemi-pulp flaps are established for finger reconstruction but infrequently applied to toe reconstruction.
• Toe pulp defects often require sensory flaps for optimal functional and aesthetic outcomes.
• This case explores a novel application of hemi-pulp flaps in toe reconstruction.

Observation:

• A free hemi-pulp flap was harvested from the contralateral second toe to reconstruct a defect in a replanted third toe.
• The patient sustained a complete third toe amputation and proximal phalanx fracture of the second toe.
• The reconstruction addressed post-necrotic tissue defects in the replanted third toe.

Findings:

• The reconstructed third toe exhibited favorable aesthetics three years post-surgery.
• Sensory restoration up to S2 was achieved in the flap region without pain, numbness, or complications.
• The donor site on the second toe showed minimal scarring and no pigmentation issues.

Implications:

• This technique presents a low-invasive, aesthetic, and functional option for toe pulp reconstruction.
• The use of contralateral second toe hemi-pulp flaps demonstrates potential for excellent sensory recovery and tissue integration.
• This method addresses the need for sensory flaps with optimal texture, feel, and shear properties in toe reconstruction.