Lateral Toe Pulp Flap Used in Reconstruction of Distal Dorsal Toe Defect

Abstract

Background When the distal dorsal part of the great toe is injured, especially with exposure of a tendon, bone, or joint, applying a free or local flap is difficult because of the lack of locally available tissue for reconstruction. Management of the distal dorsal part of a great toe soft tissue defect can be challenging for plastic surgeons. Patient and Method An 18-year-old woman presented with an injury to the dorsal aspect of her right great toe caused by a cobra bite. After fasciotomy, the wound showed exposure of the extensor hallucis longus tendon. After demarcation and infection control, the wound was reconstructed using a lateral toe pulp flap of approximately 3.5 × 1.0 cm2. The flap was transposed to the defect, and the donor site was closed primarily. Toe pulp flaps are mainly used to reconstruct finger pulp defects and are useful because they provide a glabrous skin flap suitable for resurfacing fingertip injuries. A lateral toe pulp flap uses a homodigital adjacent skin flap, which is transposed to cover the soft tissue defect. Using a quick and straightforward procedure, we designed this flap to reconstruct a distal dorsal defect of the great toe, with minimal morbidity at the donor site. Results The flap initially showed mild congestion but survived completely. Conclusions Applying a lateral toe pulp flap is a quick, simple, and reliable 1-stage procedure. It may be an effective option in reconstructing distal dorsal defects of the great toe.

A Case Report of Reconstruction of the Great Toe with a Homodigital Island Flap

“…This method was first reported by Niranjan et al 3 for great toe defects and has also been used for reconstruction of neuropathic great toe ulcers in diabetics. 4 A variation as a lateral toe pulp flap of the great toe has also been reported by Cheng et al 5 The above case highlights the potential of this flap as a "substitute" of the great toe's nail, since the aesthetic result is significantly more optimal than the other simpler methods of closure, without compromising functionality or a large donor surface. It is also a reminder that local flaps are very useful in the plastic surgeon's workforce and should never be forgotten or underestimated as a simpler and effective reconstructive tool.…”

Great Toe Tip Reconstruction after Severe COVID-19 Using Hemi-pulp V-Y Advancement Flap: A Case Report

“…Using this technique like the oblique triangular flap (1980, Vankataswami R 5 ) for fingertip reconstruction is common, but its application in toe reconstruction has been rarely reported. Li-Fu Cheng et al 6 have reported the flap for skin defects on the dorsum of the first toe due to trauma, but there are no existing reports of the flap for the apex of toe.…”

Mimical Reconstruction and Aesthetic Repair of the Nail After Resection of Subungual Melanocytic Nevus

“…Currently, few studies focus on the toe pulp aps for reconstructing the nail defects. Cheng et al reported a lateral toe pulp ap for repairing the dorsal toe defect [25] . Tashiro et al reported a second-toe lateral hemipulp ap transfer to cover a third-toe pulp defect [26] .…”