Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap

Abstract

Objective In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases. Patients and Methods From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24–33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap. Results All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16–163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200–230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet. Conclusions The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.

Various Free Flap Reconstruction Techniques after Hand and Foot Melanonychia Ablation: A Case Series

“…Even though the pedicle is short, there is no specific problem in vessel anastomosis. No large scars are left on the hands or feet [8,9]. This leads to cosmetic improvements and avoids prolonged surgical times.…”

Combined great toe dorsal nail-skin flap and medial plantar flap for reconstruction of degloved finger loss

“…The further improvements, described in the literature, in a wraparound fashion include the following: (1) extend proximally with a dorsalis pedis flap for the coverage of the dorsal finger; (2) combine with a second toe tibial flap for the coverage of the volar finger; (3) extract the dorsal nail-skin flap with a fibular hemipulp flap, supplied by the neurovascular bundle; (4) preserve the plantar triangular flap, instead of a few tibial strips 11 ; (5) sculpture the iliac bone graft into a conical contour to prevent bulging pulp 12 ; (6) dissect a great toe hemipulp flap with a second toe nail-skin flap for coverage of the distal finger; (7) combine ipsilateral second toe dorsal nail-skin flap with the contralateral second toe fibular flap for coverage of the distal finger 13 ; and (8) use bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of the distal finger. 14 In the twist-toe technique for finger reconstruction, the tip of the distal phalanx could be taken with the nail to preclude nail deformity. 15 The toe-to-hand transfer had been used in past decades; its worse appearance and loss of toe contradict our experience.…”

The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory

“…By increasing the exposure of the nail root from 0.3 to 0.4 cm, although the appearance of the nail was restored, the normal length of the nail and finger was still missing because the defects of the nail bed and fingertip had not been restored. Wang et al [ 16 ] used bilateral free lateral hallux nail flap combined with the bone to treat seven distal interphalangeal joint defect cases with an average follow-up of 93.4 months. The results showed that the injured fingers had a good appearance and sensory and motor function.…”