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

Abstract

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.

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

“…A free flap is recommended when a local flap is not suitable because the defect is too large and complex to repair 10 . A lateral great toe flap, a second toe pulp flap, or a toe nail flap are proven to be reliable techniques with a high survival rate to provide excellent aesthetics and sensory recovery 18–23 . Owing to the similar skin properties between the hands and feet, these flaps are increasingly the first choice for hand surgeon because of the characteristics of being threaded, wear-resistant, and realistic in appearance.…”

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

“…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.…”

Commentary on Letter to the Editor After “Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve” by Shuang Wang, Annals of Plastic Surgery, 2023

“…However, it is easy to leave pigmentation and form scar contracture after surgery, which affects the sensory recovery of the finger pulp. In addition, the abrasion resistance of the skin piece is poor, thus the method is not suitable for fingers with bone or tendon exposure 1 …”

“…To the Editor: W e read with great interest the recent original article by Wang et al, 1 "Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve," published in the Annals of Plastic Surgery. In this study, the authors introduced a reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defect.…”

“…In addition, the abrasion resistance of the skin piece is poor, thus the method is not suitable for fingers with bone or tendon exposure. 1 Free flaps can yield good appearance and function for finger pulp defect with bone and tendon exposure. However, the technique requires vascular anastomosis, prolongs operating times, and carries a risk of anastomotic failure.…”