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

For patients with small-area emergency finger injuries and short venous defects, using the traditional second toe tibial free flap with dorsal toe veins would increase donor site damage and compromise the esthetic outcomes of both hands and feet. This study presents an innovative harvesting technique for the second toe tibial free flap, specifically designed for fingertip or volar pulp defect reconstruction.

From March 2020 to June 2023, our institution managed 15 cases of finger pulp or fingertip defects using second toe tibial flaps with plantar vein grafts, involving 16 digits. The cohort comprised 10 males and 5 females aged 20-60 years mean 38 years. All patients underwent immediate reconstruction with free second toe tibial flaps. Surgical procedures included: anastomosis of the plantar artery to the digital proper artery, plantar vein to palmar vein, and plantar nerve to digital proper nerve.

Postoperative outcomes were assessed using two-point discrimination (2-PD), modified Vancouver Scar Scale (mVSS), Michigan Hand Outcome Questionnaire (MHOQ), and total active joint mobility (TAM). All 16 flaps survived without postoperative complications. The mean follow-up period was 11 months (range 6-18). Quantitative outcomes: Mean 2-PD: 9 mm (range 7-12). Donor site mVSS: 5 (range 4-7). Recipient site mVSS: 5 (range 4-7). MHOQ score: 8 (range 5-11). Thirteen patients reported complete satisfaction with reconstructed digit function and esthetics, while two expressed partial satisfaction. No prominent scarring was observed at foot donor sites. No secondary complications occurred during follow-up.

The modified free second toe tibial flap technique demonstrates favorable clinical outcomes for digital pulp/tip reconstruction, achieving functional restoration with minimal donor site morbidity. This approach represents a valuable technique for widespread clinical adoption.