Reconstruction of Fingertip or Pulp Defects Using the Free Second Toe Tibial Flap With Plantar Vein

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Traditional second toe tibial free flaps can cause significant donor site damage and compromise aesthetics in finger reconstruction.
• Short venous defects in emergency finger injuries pose challenges for conventional flap techniques.

Purpose of the Study:

• To present an innovative harvesting technique for the second toe tibial free flap tailored for fingertip or volar pulp defect reconstruction.
• To evaluate the clinical outcomes and donor site morbidity of this modified flap technique.

Main Methods:

• A cohort of 15 patients (16 digits) with finger pulp/tip defects underwent immediate reconstruction using free second toe tibial flaps with plantar vein grafts.
• Surgical procedures involved precise microvascular anastomosis of plantar vessels and nerves to digital counterparts.
• Postoperative assessment included two-point discrimination, modified Vancouver Scar Scale, Michigan Hand Outcome Questionnaire, and total active joint mobility.

Main Results:

• All 16 flaps survived with no postoperative complications, achieving a mean follow-up of 11 months.
• Functional outcomes showed a mean two-point discrimination of 9 mm and good joint mobility.
• Aesthetic outcomes were favorable, with minimal scarring at donor sites and high patient satisfaction (13/15 complete satisfaction).

Conclusions:

• The modified free second toe tibial flap technique provides excellent functional and aesthetic results for digital pulp/tip reconstruction.
• This approach minimizes donor site morbidity, making it a valuable option for widespread clinical adoption.
• The technique offers a successful alternative for complex finger defect reconstruction.