Reconstruction of the Distal Finger with Partial Second Toe Transfers by Means of an Exteriorised Pedicle

Abstract

This study reports the outcome of a series of ten microsurgical fingertip reconstructions with partial toe transfers in which the vascular pedicle was exteriorised and subsequently excised after the transfer had become established. The aim of this technique was to provide better aesthetic and functional outcomes. The technique was successful and without complication in nine of the ten patients who had excellent functional and aesthetic outcomes. Arterial thrombosis resulted in partial necrosis of the fingertip in the other case.

Trends in the Level of Evidence in Clinical Hand Surgery Research

“…5 For example, Brunelli et al assessed the functional and aesthetic outcomes following exteriorization the pedicle in partial second toe transfer for reconstructing the distal phalanx in 10 patients. 4 Case series are frequently the only appropriate study type in evaluating novel surgical techniques in a rare cohort of patients, as demonstrated by Brunelli et al However, the absence of a control group and overwhelming selection and observation biases justify the low allocation of case series in hierarchical evidence pyramid. The inclusion of a control group within the research design, as seen in cohort studies, provides a temporal framework for the assessment of causality, consequently improving the quality of research.…”

Hand Injuries in Children

“…For short defects, particularly of sensory nerves, alternative conduits can be effective and are attractive in minimizing donor site morbidity in children, who have the advantage of greater potential for functional recovery. These alternative conduits include the biological conduits of vein [ 71 ], muscle [ 72 ] or a vein fi lled with muscle [ 73 ], or biodegradable engineered conduits of polyglycolic acid [ 74 ], collagen [ 75 ] or caprolactone [ 76 ]. For proximal nerve injuries, where the prognosis for recovery is limited given the delay in reinnervation, transfer of an expendable functioning nerve adjacent to the denervated target has some advantages [ 77 ].…”

Double-pivot proper digital artery perforator flap for fingertip reconstruction

“…However, partial or total flap loss is not uncommon. For instance, 3 out of 7 patients were reported to experience flap necrosis with respective proportions of 30%, 40% and 80% [ 7 ]. In a review of 166 cases by Chen et al [ 9 ], venous congestion was seen in 18 patients (10%), and partial flap necrosis was observed in 14 patients (8%) [ 8 ].…”