Clinical application of the 'like-with-like' split toe flap technique for reconstruction of soft tissue defects in...

Conventional methods for reconstructing multiple digital soft tissue defects often result in significant donor-site morbidity and suboptimal functional outcomes. This study aimed to evaluate an innovative application of the "like-with-like" split toe flap (STF) technique for single-stage reconstruction of multiple digits while optimizing functional and esthetic outcomes and preserving donor-site function.

A prospective case series was conducted in six patients presenting with multiple digital soft tissue defects. Technical innovations included layered debridement, precision flap design using a three-anchor-point method tailored to defect dimensions, and digital-vessel-level microanastomosis between the flap vessels and the corresponding recipient proper digital arteries and available superficial or dorsal digital veins. Postoperative monitoring included color Doppler flowmetry, temperature monitoring, and clinical assessment.

Six patients (4 male, 2 female; mean age, 32.8 ± 8.7 years) underwent reconstruction of 12 injured digits. All flaps survived completely over a mean follow-up period of 10.2 ± 2.8 months. Sensory recovery was excellent, with a mean static two-point discrimination of 4.9 ± 0.8 mm. Donor-site function was clinically preserved in all patients, although the uniform American Orthopaedic Foot & Ankle Society (AOFAS) scores of 100 points suggested a possible ceiling effect of this scale in this small cohort. Patient-reported satisfaction was high (VAS: 9.2 ± 0.7 points), and no patient reported significant donor-site pain or functional impairment.

The "like-with-like" STF technique is a reliable option for multiple digital reconstructions. Its advantages include a single-pedicle multiple-flap design, donor-site functional anatomy preservation, and refined microanastomosis, supporting functional and esthetic recovery with minimal donor-site morbidity.