Second Toe Medial Plantar Free Flap for the Pulp Reconstruction of Fingertip

ABSTRACT

The aim of this study is to report usefulness and postoperative results of the second toe medial plantar free flap for fingertip reconstruction. From July 1997 to December 1999, 17 fingers of 17 patients with pulp defect of fingers were reconstructed by second toe medial plantar free flaps. The artery and nerve of the flap is obtained from the second toe medial plantar neurovascular bundle. Venous flow is obtained from dorsal vein. The donor site was closed with a full-thickness skin graft. The survival of these flaps was successful in all cases. All procedures were performed by the two-team approach. Average flap size was 2 X 2.5 cm. The follow-up period ranged from 2 months to 29 months. The mean value of moving and static 2 point discrimination test in 14 cases were 4.4 and 6.2 mm, respectively. We have obtained satisfactory sensory restoration and aesthetic appearance. No functional deficit was found at the donor site. We reviewed the medical records of our cases and analyzed them in several aspects. The major advantage of this flap is to provide aesthetic improvement of the recipient and donor site. We also modified the incision line of the second toe by including the medial portion of the flap, which is easier to dissect and enables neurovascular pedicles to be dissected in one operative field. We conclude that this surgical method is a safe and reliable procedure with a high successful rate for reconstruction of fingertip injury, especially for the pulp defect.