Aesthetic Reconstruction of Fingertip Defect Using Second Toe Pulp Free Flap

Background: Varioaus methods are available to address fingertip injuries, which are becoming increasingly common. Coverage should ideally involve both functional and aesthetic improvements. The second toe pulp-free flap is useful because of its similarity to the fingertips in shape, texture, and sensation. Herein, we present our clinical experience and surgical methods for fingertip defect reconstruction using second toe pulp-free flaps. Materials and Methods: Between April 2022 and May 2023, 13 toe pulp-free flaps were used to reconstruct fingertip defects. The average patient age was 50.1 years (range, 35-67 years), and nine of the 13 patients were male. Nine patients were injured on the right hand, and four on the left hand. After complete debridement, a toe-pulp flap was harvested with a teardrop from the ipsilateral side. The cases included the reconstruction of four index fingers, seven middle fingers, and two little fingers. Functional and aesthetic assessments were performed postoperatively. Results: All flaps survived completely, with no partial necrosis. The average flap size was 1.5 × 2 cm (range, 0.8 × 1.5 to 2.0 × 3.0 cm). None of the patients had functional impairments. No emergency surgeries were required during the follow-up period. The median follow-up period was 28 months, and the median duration of surgery was 119 min (range, 100-140 min). The average static two-point discrimination score for the injured finger pulp was 3.7 mm (range, 2-5 mm), the Quick Dash score was 3.4 (range, 2.3-4.2), and the Vancouver scar scale was 1.5 (range, 0-2). Conclusions: The toe pulp-free flap is the optimal choice for surgical treatment of fingertip defects and injuries, with excellent functional and cosmetic results.