Toe Partial Pulp Free Flaps in Multiple Digits Reconstruction

Lee, Dong Chul; Kim, Jong Koo; Paik, Hyung Ik; Rho, Si Young; Ki, Se Whi; Kim, Jin Soo

Abstract

Reconstruction of a finger-pulp defect is one of the most difficult procedures. The reasons are that the identical donor tissue is not easy to obtain and the reducing the donor site morbidity is not easy to achieve. Particularly, reconstruction of multiple digit pulp defect is more difficult. We propose toe partial pulp free flaps for the replacement of defects of multiple fingertip. It can provide identical color matching to donor defect, and cut down the morbidity of donor site. The 33 digits of 15 patients were treated with this method. The donor sites were medial aspect of the second toe or third toe and lateral aspect of big toe. The neurovascular pedicles were composed of medial plantar digital artery, medial plantar digital nerve, and superficial plantar vein of the second toe, third toe or big toe. All flaps were survived. The average of static two-point discrimination was 5.9 mm. Primary closure of donor sites was possible in all cases. Toe partial pulp free flaps has many advantages in multiple digit reconstruction. It can provide excellent color and texture matching, excellent sensory recovery. It avoids long term immobilization. Vascular anatomy was so consistent that vessels were easily dissected. Primary closure of donor site was possible. However, there were some restrictions. The flap could not be applied to a large defect, and to patients with vascular disease and old age. It also required skillful technique in anastomosis of pedicle. In conclusion, we consider that toe partial-pulp free flaps are useful method to reconstruct the defects of multiple fingertips.