Finger Reconstruction with a Free Neurovascular Wrap-Around Flap from the Big Toe

Abstract

From 1983 to 1998, 16 cases of finger reconstruction with a free neurovascular wrap-around flap from the big toe were treated. Fourteen cases were successful, and two cases failed. The authors reviewed these cases on the average of about 38 months after surgery. Pinch power was 51 percent of the unaffected normal hand, and two-point discrimination was 7.6 mm. The mean resorption of the grafted bone was 13 percent in width and 9 percent in length. There were no complications such as fracture of the grafted bone, nonunion, and pulp dislodgement. This procedure provided length, stability, and adequate sensibility for a functional pinch and grasp. Sensory return to the wrap-around flap on the thumb was often greater than for the same area on the opposite foot. The donor site of the wrap-around flap was acceptable, both aesthetically and functionally, and allowed the wearing of open-toed shoes by young women. Finger reconstruction with a wrap-around flap from the big toe yielded excellent cosmetic and functional results in cases involving amputation at the level of the metacarpophalangealjoints or distal to it. In addition, this procedure was an excellent choice for treatment in cases involving avulsion injuries of the fingers and reconstruction of soft-tissue defects after tumor excision.

Salvage of Sensation in a Hallux-to-Thumb Transfer by Nerve Tube Reconstruction

“…For example, in a recent series of patients with these reconstructions, followed up for an average of 38 months, the mean static 2-point discrimination was 7.6 mm. 8 According to Hahn et al, "Sensory return to the wrap-around flap on the thumb was often greater than for the same area on the opposite foot." 8 The original principles of sensory re-education first described for rehabilitation after nerve repair or grafting 5 have been applied successfully to the transplanted toe.…”

“…8 According to Hahn et al, "Sensory return to the wrap-around flap on the thumb was often greater than for the same area on the opposite foot." 8 The original principles of sensory re-education first described for rehabilitation after nerve repair or grafting 5 have been applied successfully to the transplanted toe. 6 It has become clear that the more nerves that are reconstructed for the transplanted toe, the better the reinnervation of the transferred tissue's target end organs, the sensory receptors in the toe pulp.…”

“…8,9 Recovery of sensibility should be the standard of care. For example, in a recent series of patients with these reconstructions, followed up for an average of 38 months, the mean static 2-point discrimination was 7.6 mm.…”

Free medial plantar artery perforator flap for finger pulp reconstruction: Report of a series of 10 cases

“…12 The convex contour of the toe pulp is similar to that of the finger pulp. [19][20][21] However, because the donor site of lateral first-toe flap may require a skin graft for resurfacing, 19 patients who undergo the procedure may be dissatisfied with the painful and unsightly scar in the donor site, which would be visible when wearing open-toed sandals. The MPAP flap meets the above criteria, and the similar anatomic characteristics of the plantar surface make it the preferred donor site for fingertip reconstruction.…”

Free great toe wrap‐around flap combined with second toe medial flap for reconstruction of completely degloved fingers

“…13 Free wrap-around flaps from the great toe or second toe have been utilized in the reconstruction of degloved fingers with success. [14][15][16] However, conventional wrap-round flap of toe are usually insufficient to cover the skin defects of the entire degloved fingers because of the size limitation of the flap that can be harvested.…”