Repair of Minor Tissue Defect in Hand by Transfer of Free Tissue Flap from the Toe

Document Type : RESEARCH PAPER

Authors

1 Orthopedics Department, The Eight Affiliated Hospital of Guangxi Medical University, 537100, Guigang, China

2 Department of Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530000, Nanning, China

Abstract

Background:
 
To introduce our experience of using the free neurovascular flap from great and second toe.
Methods:
 
Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical
institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were
applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side
flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap
with distal digital bone of second toe.
Results:
 
All flaps were survived. The average subjective satisfaction score was 8.08 (range 4-10). Nine patients
(69%) experienced cold intolerance, and 2 patients (15%) dysesthesia. The Semmes-Weinstein sensitivity score was
between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range
4-12). Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less
than 15 degrees.
Conclusions:
 
Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue
defect in hand.

Keywords


  1. Yamada N, Ui K, Uchinuma E. The use of a thin abdominal flap in degloving finger injuries. Br J Plast Surg. 2001;54(5):434-8.

  2. Ulrich D, Pallua N. Treatment of avulsion injury of three fingers with a compound thoracodorsal artery perforator flap including serratus anterior fascia. Microsurgery. 2009;29(7):556-9.

  3. Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am. 1980;5:575-83.

  4. Hahn SB, Park HJ, Kang HJ, Kang ES. Finger reconstruction with a free neurovascular wrap-around flap from the big toe. J Reconstr Microsurg. 2001;17(5):319-24.

  5. Sukop A, Tvrdek M, Dusková M, Padera J. Degloving injury--the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction. Acta Chir Plast. 2005;47(4):107-11.

  6. Henry M, Levaro F, Masson M, Clifton J. Simultaneous three-flap reconstruction of extensive hand and finger degloving injury: case report. J Reconstr Microsurg. 2002;18(5):387-92.

  7. Chen SL, Chou GH, Chen TM, Wang HJ. Salvage of completely degloved finger with a posterior interosseous free flap. Br J Plast Surg. 2001;54(1):69-71.

  8. Takeuchi M, Sakurai H, Sasaki K, Nozaki M. Treatment of finger avulsion injuries with innervated arterialized venous flaps. Plast Reconstr Surg. 2000;106(4):881-5.

  9. Henry M. Degloving combined with structural trauma at the digital level: functional coverage with fascial free flaps. J Reconstr Microsurg. 2007;23(2):59-62.

  10. Foucher G, Merle M, Maneaud M, Michon J. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg. 1980;65(5):616-27.

  11. Tubina R, Thomine JM, Mackin E. Examination of the hand and upper limb. 1st Ed. Philadelphia: Saunders. 1984; 98-108.

  12. Rui Y, Mi J, Shi H, Zhang Z, Yan H. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery. 2010;30(6):449-56.

  13. Iñigo F, Gargollo C. Secondary coverage of the hand using a dorsalis pedis plus first web space free flap. J Reconstr Microsurg. 1992; 8(6):461-5.

  14. Woo SH, Choi BC, Oh SJ, Seul JH. Classification of the first web space free flap of the foot and its applications in reconstruction of the hand. Plast Reconstr Surg. 1999;103(2):508-17.

  15. Küntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg. 2001;108(4):885-96.

  16. Rui Y, Shou K, Zhang Q, Xu Y, Sun Z, Xu L. Combined free-tissue transfer for primary reconstruction of radial part of the hand. Microsurgery. 2004;24:59-62.

  17. Fan CY, Jiang J, Zeng BF, Jiang PZ, Cai PH, Chung KC. Reconstruction of thumb loss complicated by skin defects in the thumb-index web space by combined transplantation of free tissues. J Hand Surg Am. 2006;31(2):236-41.

  18. Cong HB, Chang SM, Qiao YP, Wang CL, Sui HM, Cong L. One-stage reconstruction of complicated thumb injury with combination of microsurgical transplantations. Microsurgery. 2007; 27(3):181-6.

  19. Wei FC, Chen HC, Chuang DC, Chen S, Noordhoff MS. Second toe wrap-around flap. Plast Reconstr Surg. 1991;88(5):837-43.

  20. Doi K. Microsurgical thumb reconstruction--report of six cases with a wrap-around free flap from the big toe and an iliac bone graft. Ann Acad Med Singapore. 1982;11(2):225-30.

  21. Deglise B, Botta Y. Microsurgical free toe pulp transfer for digital reconstruction. Ann Plast Surg. 1991;26(4):3416.