Aesthetic reconstruction of thumb or finger partial defect with trimmed toe‐flap transfer

Abstract

A new concept of esthetic reconstruction for partial loss of distal finger segment was introduced. In a series of 77 patients, 80 thumb or finger partial defects of lateral, dorsal, or volar half, or composite tissue defect of the finger body were reconstructed with lateral skin-nail flap, dorsal skin-nail flap, pulp flap, or composite tissue transplant taken from corresponding part of the toes. The blood circulations were reestablished by anastomosing digit arteries of the toe transplants and fingers. Seventy-eight fingers in 75 patients of this series were successfully reconstructed. The overall survival rate was 97.5%. Follow-up examinations made half to 12 years postoperatively showed normal length, outward appearance, and function of the reconstructed digits. Their nails are preserved or reconstructed. The pulps are full. Sweating is present. 2-PD was 4-6 mm. Esthetic reconstruction can achieve the goal of mending any part of tissue loss precisely with good result.

One-stage cosmetic finger reconstruction using a second toe island flap containing terminal branches of the toe artery

“…The surgical procedure is simple, safe, and effective with satisfactory outcomes [13]. The morphological transition after repair is natural, and a second procedure is not needed.…”

“…However, the technique cannot eliminate the stenosis in the neck of the finger pulp. Two-stage spindle-shaped excision at the side of the finger pulp is a simple and safe procedure with short operative time [13]. However, it does not improve stenosis in the neck of the finger pulp and it also involves a second surgery.…”

“…Mild clubbing in the distal phalanx can be resolved by fixing the distal interphalangeal joint in a hyperextended position during surgery. However, the other 2 deformities are difficult to manage and the outcomes are poor [13][14][15][16][17].…”

Soft Tissue Cover of the Hand

“…Free fl ap reconstruction of the digits has more recently been extended by some authors to include aesthetic considerations alone [ 65 , 70 ]. Cheng et al reviewed a series of 80 cases of partial toe, toenail and toe pulp transfers for aesthetic reconstruction of digits (of which 29 were of non-thumb digits), with a 97.5 % survival rate, and 2PD varying from 4 to 10 mm [ 70 ]. In a review by Del Pinal, the conventional notions of toe pulp transfer are also challenged and microvascular transfer is performed within the acute trauma period, and is recommended particularly in manual workers [ 65 ].…”

Functional and aesthetic results of immediate reconstruction of traumatic thumb defects by toe-to-thumb transplantation

“…When there was transverse defect, oblique defect, or longitudinal partial defect of the distal thumb, an osteo-onychocutaneous flap from the great toe, was chosen for thumb reconstruction as described in published reports [6,8,9]. If the defect was subtotal, or total distal thumb at the level of the interphalangeal (IP) joint, we would use a partial great toe transplantation to reconstruct tissue defects.…”