Fingertip Reconstructions Using Partial-Toe Transfers

Abstract

Fifty-six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo-onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo-onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes-Weinstein test) and 6.3 mm (moving two-point discrimination) at 2.6 years after the transfer; those of the thin osteo-onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery.

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction

“…The muscles remained intact, and the strength of the operated arm was not reduced because the muscular branches of the radial nerve were uninjured [32]. Even very small vessels (\1 mm) can be anastomosed with high success rate, but harvesting a flap by an extensive proximal exposure incision to find suitable vessels (i.e., those that are sufficiently large for anastomosis) was still necessary [10,26].…”

Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects

“…Certain aspects of the reconstruction technique used in this study can render a favorable option relative to previously published methods. Given that very small vessels (<1 mm) can be anastomosed with a high rate of success, harvesting a flap by using an extensive proximal exposure incision to find vessels that are sufficiently large for anastomoses becomes unnecessary [25,26].…”

Bilateral V–Y Rotation Advancement Flap for Fingertip Amputations

“…However, there is a consensus that replantation is the best choice by maintaining the length of the finger and the normal anatomy of the nail complex, if only the amputated fragment is available, in replantable condition and well preserved [34,42]. If replantation is not possible, reconstruction ladder could be used for fingertip injuries: secondary healing, primary closure, skin grafting, homodigital flaps (V-Y advancement [4], V-Y cup [41], dorsal visor [20], Kutler [25], Moberg [35], hatchet [4], Hueston [10], linguiform rotation [12], dorsal adipofascial flaps [26,28,40], cross-finger flap [20,25], island flaps (homodigital [5,7,13,29,38], heterodigital [30] and metacarpal [19]) (antegrade and retrograde [38]), digital artery perforator flaps [23], distant flaps (thenar flap [10], groin and abdominal), free flap (free toe pulp [9,22,31], venous [33,39] and medial plantar perforator [17,42]). …”

“…Reconstruction with free flaps such as partial second toe pulp flap [31], venous flap [21,45], medial plantar perforator flap and trimmed toe tip method [22] replaces the fingertip with similar glabrous tissue. However, these operations that are time-consuming and costly require experienced surgeons and special fine instruments.…”

“…Patient's general health condition and smoking habits are very important for flap perfusion. Free pulp or hemipulp transfers' sensory results are excellent [9,22], but these results could be also obtained by local flaps. Lee et al points out that a high proportion of the reconstructed fingers need additional surgeries [31].…”