Partial Second Toe Pulp Flap Transfer for the Coverage of Great Toe Hemipulp Flap Donor Site

Abstract

Summary: The great toe hemipulp flap transfer is a viable reconstructive method for finger pulp defect. However, early functional recovery of the donor foot is essential for returning to daily life activities, and functional and aesthetic restoration of the donor site remains challenging. We present a case in which the great toe hemipulp flap donor site was reconstructed with pedicled partial second toe pulp flap transfer, aiming for early recovery of the donor foot and aesthetically and functionally satisfactory donor-site reconstruction. A 62-year-old man underwent left little finger-pulp crush amputation in Tamai zone 2 and received free great toe hemipulp flap transfer. For the defect following flap harvest, the partial second toe pulp flap was elevated and transferred. The donor site of the partial second toe pulp flap was primarily closed. The postoperative course was uneventful, and the patient started walking on postoperative day 2. Postoperatively, the sensory recovery of the transferred flap was excellent, and the reconstructed great toe was functionally and aesthetically satisfactory. The pedicled partial second toe pulp flap transfer may be a viable alternative for the coverage of great toe hemipulp flap donor site.

The modified second toe flap technique based on the dorsal digital artery of the toe in finger pulp reconstruction

“…They mainly consider the flap donor site to be relatively covert with less impact on future life and work. Buncke (Buncke & Rose, 1979;Hattori et al, 2022;Kimata et al, 1998;Kwon et al, 2021;Lee et al, 2008). As a momentous functional region, the pulp of the toe is essential for walking and weightbearing.…”

“…In 1998, Kimata et al (1998) reported the classical second toe plantar flap technique based on advantages, such as anatomic similarities, sense reconstruction, and minimum anatomic variations. According to previous reports, the second toe free medial flap for fingertip reconstruction, but function and esthetics of the second toe are greatly affected by this (Buncke & Rose, 1979; Hattori et al, 2022; Kimata et al, 1998; Kwon et al, 2021; Lee et al, 2008). As a momentous functional region, the pulp of the toe is essential for walking and weight‐bearing.…”

“…The flap survived without severe adverse events. Although the plantar digital artery and nerve were widely applied as neurovascular bundle in the previous second toe pulp free flap or tibial second toe free flap technique, some short‐term postoperative complications, including arterial spasm and partial margin necrosis, have been reported (del Piñal et al, 2007; Hattori et al, 2022; Hong et al, 2020; Zhang et al, 2022). In our patients, all flaps survived without severe adverse events, except for one patient who developed a pale flap shortly after surgery.…”

“…According to previous studies, free flaps with sensory nerves have produced favorable surgical outcomes (Gu et al, 2014). A free flap dissected from a covert site is ideal for the repair of finger pulp defects; it mainly reduces secondary injuries of injured fingers and restores the appearance and sensory function of the fingertip (Hattori et al, 2022; Kim et al, 2016). The second toe free medial flap technique has a great help to restore function and appearance of the finger pulp.…”

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer

“…Compound tissue transfer from a toe to a finger meets all the requirements for a newly rebuilt finger. Nicoladini 12 first repaired a lost thumb using a pedicle great toe transfer. Dongyue 13 successfully reconstructed a lost thumb with a free second toe transfer in 1966, and Cobbett 14 applied the free great toe transplantation in 1968, extending the methods of utilizing the toe tissue transfer to reconstruct a finger or a portion of a finger.…”