Use of non-enhanced angiography to assist the second toetip flap transfer for reconstruction of the fingertip defect

Abstract

Toetip flap transfer is a useful reconstructive method for fingertip defect, but elevation of a toetip flap is technically demanding because of difficulty to dissect a pedicle vein of the flap. Recently, nonenhanced angiography (NEA) has been reported to be useful for preoperative visualization of the digital vessels without contrast enhancement or invasiveness. We report a case in which preoperative NEA visualized a vein suitable for a venous pedicle of a second toetip flap and facilitated successful toetip flap transfer for reconstruction of a fingertip defect. A 27-year-old male suffered from the right middle fingertip crush amputation in Tamai zone 1. The fingertip was reconstructed using a second toetip flap with preoperative NEA guidance. A pedicle vein was easily found and dissected exactly where NEA visualized. Nine months after the toetip flap transfer, the reconstructed right middle finger was functionally and aesthetically pleasing, and the toe nail at the donor site was preserved without any morbidity. NEA may help a surgeon to find drainage veins for a toetip flap, which leads to easier and more secure toetip flap transfer.

A perforator from the ulnar artery and cutaneous nerve of the hypothenar area: An anatomical study for clinical application

“…Recently, fingertip reconstruction methods have changed significantly with the development of microsurgery, which enable the anastomosis of blood vessels with a diameter of less than 1 mm. Free flap reconstruction, which was previously not used for treating fingertip injuries, has been introduced in fingertip reconstruction along with the use of perforator flaps . The partial second toe pulp free flap, which was introduced by Lee et al in 2008, demonstrated successful fingertip reconstruction with a free flap that included an artery, vein, and nerve, with excellent results seen even in small amounts of tissue.…”

“…Recent advances in microsurgery that enables the anastomosis of blood vessels smaller than 1 mm have led to extensive changes in fingertip reconstruction. A free flap, characteristically used for the reconstruction of extensive tissue defects, has been applied in fingertip reconstruction . Further, reconstruction methods involving a perforator flap that preserves the main vessel have also been introduced …”

Transversely‐inset great toe hemi‐pulp flap transfer for the reconstruction of a thumb‐tip defect

“…Thumb‐tip defect can be treated with various reconstructive methods such as local flaps and free flaps . For thumb‐tip defect with bony defect, toe‐tip flap transfer offers an optimal treatment results, because it can restore all anatomical structures in the thumb‐tip with anatomically similar toe‐tip flap; it is important to reconstruct the distal phalanx with full length for prevention of claw nail deformity . For thumb pulp defect without bony or nail bed defect, local flaps such as volar advancement flap is enough to reconstruct the defect, but it is difficult to reconstruct a thumb‐tip defect with advancement flaps when a defect is larger than 4 cm and/or includes nail bed defect .…”

“…Free toe‐tip flap is useful to reconstruct defect of digital tip, which allows functionally and aesthetically pleasing reconstruction . Although the nail can be preserved at a donor site of toe‐tip flap, toe‐tip transfer leads to shortening of the donor toe, and elevation of toe‐tip flap is technically demanding due to difficulty of pedicle vein dissection.…”

Hands‐free vein visualizer for preoperative assessment of recipient veins

“…Several vein viewers have been reported for preoperative visualization of recipient vein, but they have drawbacks; viewer field is small, visibility is not good, and they are not hands-free. [2][3][4] Veinsite (VueTek; Gey, ME) is a hands-free head-mounted vein viewer, which has been reported to be useful for venipuncture navigation. 5 It consists of a portable near-infrared emitter, a video acquisition, and a display.…”