Partial second‐toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications

Abstract

Background Traumatic fingertip injury is a common hand injury and various methods are available to address them. The partial second‐toe pulp (PSTP) free flap is useful because of the similarity in shape, texture, and sensation to the fingertips. However, there may be many difficulties during surgery. The purpose of this report is to make the surgery easier and minimize complications by sharing the surgical tips of the authors obtained through many experiences. Patients and Methods Thirty patients who underwent PSTP free flap due to trauma were reviewed retrospectively from February 2015 to June 2018. The average age of the patients was 49.4 years. Seventeen were injured on the right side and 13 were on the left side. After removal of the injured tissue, a teardrop‐shaped flap was harvested from the medial side of the second toe. When inset, skin graft or vein graft was performed if necessary. When primary closure of the donor site was difficult, skin graft was performed (n = 21). The factors noted during surgery were analyzed. Results The flap size was 2.39 (range: 1.5–5) x 1.29 (range: 1–1.8) cm2. All flaps survived. Venous congestion was found in two patients, neuroma was found in one patient, and partial necrosis was found in two patients; all recovered with conservative care. The mean follow up periods was 5.79 (range: 2–18) months. None of the patients had functional impairment. Conclusion Successful reconstruction and enhanced functional and cosmetic effects can be achieved using surgical tips.

Comments on “Partial second‐toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications” and the use of adipofascial perforator flap for fingertip reconstruction

“…In terms of flap survival, the authors reported 7% partial flap necrosis and 7% of venous congestion with PSTP (Kwon et al, 2021); in our recent report about 15 cases of fingertip reconstruction with an adipofascial perforator flap, the same rate of partial necrosis was documented (Losco et al, 2019). No donor site complications were recorded by both study groups.…”

“…However, PSTP is an excellent reconstructive weapon in "partially degloved" fingertips with relevant bone exposure (figure 4 in authors' report) and soft tissue defects of significant size. A true comparison regarding functional and aesthetic outcome between the authors' (Kwon et al, 2021) and our (Losco et al, 2019) report could not be performed due to the limitations stated in both papers.…”

“…We read with great interest the article from Kwon et al (2021) entitled "Partial second-toe pulp free flap for fingertip reconstruction:…”

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

“…Although this procedure requires additional donor compromise in the toe aside from the great toe hemipulp and, thus, may have an increased risk of potential complications, we believe the compensation can be acceptable, considering the minimal donor-site morbidity of the partial second pulp flap and excellent outcome of the reconstructed great toe. 4,6,8 Although further clinical applications are required to confirm the feasibility and reproducibility, partial second toe pulp flap transfer may be a viable alternative for the coverage of great toe hemipulp flap donor site.…”

“…Although this procedure requires additional donor compromise in the toe aside from the great toe hemipulp and, thus, may have an increased risk of potential complications, we believe the compensation can be acceptable, considering the minimal donor-site morbidity of the partial second pulp flap and excellent outcome of the reconstructed great toe. 4,6,8…”