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Updated: Jan 17, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Staged hand-foot flap reciprocity: A microsurgical protocol utilizing great toenail flap for finger defect
Wei Zhao1, Guohui Yin2, Linfeng Liu3
1First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.
Background:
Finger defect reconstruction requires functional and aesthetic restoration. The great toenail flap demands advanced microsurgical skills. We propose a staged approach: initial pedicled flap coverage, followed by second-stage exchange of the great toenail flap with the finger flap, enhancing donor site repair while reducing complexity and expanding access in resource-limited settings.
Method:
Sixteen patients (2017-2024) underwent staged reconstruction: primary pedicled flap followed by great toenail flap-finger flap exchange. Outcomes included complications, functional metrics (Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire [MHQ], static two-point discrimination [2-PD]), and donor foot pain (Visual Analog Scale [VAS]). Healthy sides served as controls.
Results:
At mean 12-month follow-up, reconstructed fingers showed mean static 2-PD of 5 mm and Semmes-Weinstein result of 3.67 g; MHQ averaged 89.6. Foot donor sites demonstrated mean 2-PD of 5.5 mm and VAS of 1. Complications included partial flap necrosis (1 case) and significant donor foot pain (1 case). Interphalangeal joint motion, 2-PD, and MHQ scores differed significantly from healthy sides (p < 0.001)..
Conclusion:
This staged protocol provides a safe, practical solution for finger reconstruction, particularly in settings with limited microsurgical resources. It reduces primary hospital treatment thresholds and addresses suboptimal aesthetic/functional outcomes.
Therapeutic:
Level III.
