Partial second toe pulp free flaps in early childhood

Hong, Min Ki; Lee, Dong Chul; Choi, Min Suk; Koh, Sung Hoon; Roh, Si Young; Lee, Kyung Jin

doi:10.5999/aps.2020.01137

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Due to the development of microsurgical instruments and techniques, the field of supermicrosurgery has been further expanded in the last 50 years (Hong et al, 2018;Hong et al, 2020;Kwon et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…If the injury zone requires a long pedicle to reconstruct, it is feasible to extend the pedicle to the first dorsal metatarsal artery. Due to the development of microsurgical instruments and techniques, the field of supermicrosurgery has been further expanded in the last 50 years (Hong et al, 2018; Hong et al, 2020; Kwon et al, 2021). According to some articles, small vessels with diameters <0.8 mm could be anastomosed with 10–0 or 11–0 nylon sutures.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Jin

Zhang

et al. 2023

Microsurgery

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BackgroundThe second toe flap is a widely used innervated neurovascular flap for repairing finger pulp defects. It mainly carries the proper plantar digital artery and nerve. But the donor site morbidity and arterial injury are common. The report retrospectively evaluated the clinical outcomes of the second toe free medial flap based on dorsal digital artery of the toe to investigate the esthetics and function in the treatment of soft tissue defects of fingertip pulp.MethodsFrom March 2019 to December 2020, 12 patients with finger pulp defects (seven acute crush, three cut, and two burn) undergoing the modified second toe flap were chosen for retrospective review. The average patient age was 38.6 (range: 23–52) years. The mean defect size was 2.1 × 1.6 (range: 1.5 × 1.3–2.6 × 1.9) cm. The defects did not extend beyond the distal interphalangeal joint and the phalanges were not damaged in all cases. The average follow‐up was 9.5 (range: 6–16) months. Demographic information, flap data, and perioperative characteristics were collected.ResultsThe mean size of the modified flap was 2.3 × 1.8 (range: 1.7 × 1.5–2.7 × 2.0) cm and mean diameter of artery was 0.61 (range: 0.45–0.85) mm. The mean flap harvested time and operation time were 22.6 (range: 16–27) minutes and 133.7 (range: 101–164) minutes. A flap was ischemic after first day postoperatively and later it improved by releasing the sutures. All flaps were survival without necrosis. One patient was not satisfied with the appearance of the finger pulp because of scar hyperplasia. The other 11 patients were satisfied with the appearance and function of the injured digit after 6 months postoperatively.ConclusionThe modified second toe flap technique based on the dorsal digital artery of the toe is a feasible choice to reconstruct the sensation and appearance of the injured fingertip with current microsurgical techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Jin

Zhang

et al. 2023

Microsurgery

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“…Volar defects were reconstructed using volar‐side tissues and dorsal defects were reconstructed using dorsal‐side tissues. Venous flaps, thenar free flaps, hypothenar free flaps, and toe pulp free flaps have been used to reconstruct the hand (Chang et al, 2021; Hong et al, 2020; Kim et al, 2013; Kwon et al, 2021; Lee et al, 2008; Lim & Chung, 2020; Lin & Loh, 2019; Pittet et al, 2008; Sassu et al, 2008; Seo et al, 2018; Yang et al, 2010; Zan et al, 2017). However, reconstruction of multiple finger defects should be approached in a totally different way.…”

Section: Discussionmentioning

confidence: 99%

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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“…At the final follow-up, all patients were satisfied with the functional and aesthetic appearance, and no patients required additional aesthetic improvement procedures. Hong et al [ 6 ] correlated the clinical outcomes of partial second toe pulp free flaps for acromegaly in young children and showed that all 18 toe medullary flaps survived in 17 patients without any major complications. At follow-up, the flap-covered distal phalanges showed growth consistent with normal development.…”

Section: Introductionmentioning

confidence: 99%

Repair of finger pulp defects using a free second toe pulp flap anastomosed with the palmar vein

Zhang¹,

Wang

Ma³

et al. 2022

J Orthop Surg Res

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Purpose To evaluate the clinical utility of surgical reconstruction of finger pulp defects using a plantar flap derived from the toes, with vascular anastomosis of the toe-finger artery and the plantar-palmar vein of the finger. Methods Between April 2018 and November 2020, 29 patients with finger pulp defects underwent treatment via the transplantation of pulp tissue from the second toe, with the plantar vein of the toe and the palmar vein of the finger being anastomosed during this procedure. In addition, an anastomosis of the toe and finger artery and nerve was conducted, with a flap size of 1.0 cm * 0.8 cm–2.3 cm * 4.0 cm being used for such repair. Donor tissue sites were closed without introducing deformities or other complications. Results In all patients in the present study, flap tissues survived and did not exhibit evidence of vascular crisis over a mean 16.8-month follow-up period (range 8–24 months). After successful skin flap grafting, they exhibited good elasticity and a soft texture. At three months post-surgery, some patients reported partial recovery of touch sensation in the transplanted tissue, while pain recovery was evident in some patients at 4–6 months post-surgery. No deformities or other complications were observed at the donor site, and the ability of patients to walk normally was not impaired. Conclusion The anastomosis of toe plantar flaps with the palmar vein can facilitate the repair of finger pulp injuries without the need to dissect the dorsal vein of the toe, allowing for the suturing of donor tissue sites without causing any deformities or other complications. This surgical approach can easily be conducted with satisfactory clinical outcomes.

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Partial second toe pulp free flaps in early childhood

Cited by 5 publications

References 17 publications

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

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

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Repair of finger pulp defects using a free second toe pulp flap anastomosed with the palmar vein

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