Toenail Composite Tissue Flap as a Novel Reconstructive Approach in the Treatment of Macrodactyly of the Foot

Abstract

Background: The microsurgical technique has been used to dissect macrodactyly into a composite tissue flap with arteries, veins, and toenail phalanxes to reconstruct the deformed toe into a near-normal one. Methods: This study retrospectively collected relevant data from ten patients undergoing toenail composite tissue flaps to reconstruct their macrodactyly. This case series included two female and eight male pediatric patients with a mean age of 27.2 months (8–64 months), who had been followed for average 24.3 months after the reconstruction surgery (3–57 months). The American Orthopedic Foot and Ankle Society Scale (AOFAS) score was obtained by the operating surgeons before and after the reconstruction operation while all the patients completed the postoperative questionnaires. Results: The reconstruction surgery took an average of three hours with minimal intraoperative blood loss. The postoperative score of the AOFAS scale was significantly improved from the one before the surgery (33.3+/-12.4 vs. 76.3+/-10, p≤0.001). The average score obtained from the postoperative questionnaires for foot macrodactyly was 9.4 in the range between 0 and 10 for the functional and aesthetic restorations. All reconstructed toes were viable without signs of infection or necrosis and possessed satisfactory function and appearance during the follow-up period after the reconstruction surgeries. Conclusion: It is feasible and effective to dissect a macrodactyly into a composite tissue flap for being reconstructed into a nearly normal toe.