Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half–Big Toenail Flap With Minimum Donor Site Morbidity

Abstract

The vascularized halfebig toenail flap is a short-pedicle free vascularized flap approximately 30 mm in size that contains a fibular half-nail with a 5-mm skin edge and the partial distal phalanx bone. The fingertip skin of the amputated finger is reflected to cover the skin deficiency. The sensation and function are maintained at the donor site, and primary wound closure of the donor site is possible. This study aimed to evaluate the clinical outcomes of thumb and finger reconstruction operations performed using this flap. Methods: We assessed 16 patients (19 digits) with digit amputation who underwent this procedure. We evaluated the following parameters: reconstructed digits, amputation level, survival rate, period until bone union, elongated length, morphologic indices, feeding artery, vein distribution, static 2-point discrimination, and patient occupation. We used the Michigan Hand Outcomes Questionnaire for the evaluation of the function and appearance of the arm. Results: We reconstructed 3 thumbs and 16 fingers. No patients with zone I or V or palm amputation underwent surgery. Flap survival was obtained in all cases, including one atrophic case. Elongated length was 14.1 mm (range, 0e30 mm). The width and longitudinal/axial convexity of the transferred nail increased and the length decreased, whereas the width of the donor site nail increased at final follow-up. Reasonable sensation of the flap was obtained. The feeding artery was the plantar digital artery in 15 toes, the branch in 1, and the arterial anonymous vessel in 3. We could harvest the vein in the first web in 16 toes. All patients went back to their former jobs. Conclusions: The aesthetic and functional outcomes of the reconstructed thumbs and fingers significantly improved. Donor site functional morbidity was minimum. Nevertheless, patients' expectations regarding the reconstructed digit seemed to be that of an intact digit. Type of study/level of evidence: Therapeutic IV.

Selection Bias in Avoiding Vein Graft in Replantation/Revascularization May Exist in Distal and Proximal Amputations, Respectively

“…Moreover, we performed additional reconstructive surgery to maximize surgical benefit, and attempted to improve the appearance and function. 19 This study has several limitations. First, this was a retrospective study.…”

“…Moreover, we performed additional reconstructive surgery to maximize surgical benefit, and attempted to improve the appearance and function. 19 …”

Osseointegrated Metallic Implants for Finger Amputees: A Review of the Literature

“…Moreover, the osseointegrated patient, in absence of complications, can immediately come back to work, while the patients treated with external fixator need a recovery time of at least 3 months 9,29 with a consequent expense to be paid by health insurance fund. Finally, pollicization damages the donor site and may lead to vascular complications, 30 while osseointegrated prosthesis does not affect any other anatomical site. Figure 1 pictures the qualitative impact of four relevant variables in the cost assessment.…”

Easy and Simple Techniques to Reconstruct Natural Nailfold with the Wrap-around Flap for Finger Reconstruction

“…These techniques stably reconstruct the natural bulge of the lateral nail fold and the natural roundness of the proximal nail fold, yielding a successful cosmetic outcome (►Fig. 5). The author used this method of reconstruction in more than 30 cases, of which flap necrosis occurred in 1 case.…”

“…Therefore, various modifications have been reported, including the following three methods: partially harvesting the nail, thinning the flap on the plantar part, and combining a small vascularized partial toenail flap and a local finger flap. 1 2 3 4 5 However, the partial nail transplantation tends to result in a missing nail margin, meaning a finger that appears to have no lateral nailfold on one side. 6 7 Moreover, the natural roundness from the proximal to the lateral nailfold tends to be lost.…”