The Use of the Great Toe Pulp Free Flap in Dystrophic Fingertips

Background: Lesions of the digital apices are common, and several treatment strategies can be considered for them. Among these, the free great toe pulp flap can be used. Methods: This is a retrospective report in which five patients undergoing hallux free flap surgery for loss of pulpal substance at the level of the hand were evaluated. They were re-evaluated by using both clinical testing to assess sensitivity and the use of questionnaires to estimate function. Results: None of the performed flaps failed. The mean follow-up was 36 months (range 16-66 months). With SW-MF, the mean value was 3.734 compared to 2.986 for the same contralateral finger. The S2-PD test attested a mean value of 6.8 mm (range 6-8 mm) in contrast to the contralateral finger, which showed a mean result of 3.2 mm (range 3-5 mm), while the D-2PD indicated lower values for both the operated finger, with a mean value of 6.4 mm (range 4-8 mm), and the healthy finger. Conclusions: When a dystrophic fingertip results from an inappropriate acute management, the GTP flap appears to be an excellent strategy to restore the specialized tissue of finger pulp and to bring supple tissue to the correct PIP flexion contracture or the small first web space contracture. It is mostly required for thumb and radial fingers' reconstruction, especially in young patients or those who need high functional demands and/or present an extensive loss of substance that cannot be resolved with local flaps.