Appficafion of combined wrap-around flap of the big toe and fibial flap of the second toe in treating degloving injuries of the thumb

Abstract

Objective To report the operation methods and clinical effects of combined wrap-around flap of the big toe and tibial flap of the opposite second toe in treating degloving injuries of the thumb. Melhods Eight cases of thumb degloving injuries were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe. In 2 cases, the donor site of the big toe was covered by flap transfer from the side of the adjacent second toe, while the resulting second toe skin defect was covered by full thickness skin graft. In 6 cases full thickness skin graft was used to cover the big toe donor site defects. All donor site defects on the opposite second toe were covered with full thickness skin graft. Results All 8 combined flaps survived. The wound healed primarily. Skin grafts in the donor sites of the foot also survived. Postoperative follow-up ranged from 5 to 18 months, with an average of 8 months. The flap color was the same as normal finger flap without obvious atrophy and pigmentation. The appearance of the thumb was satisfying. Thumb nail grew well. Sensory recovery from S2 to S3 ＋ was achieved in the thumb pulp. Thumb interphalangeal joint tlexion and extension were good. The donor site skin graft had no scar contracture and no ulceration. There were no malformation of toe drop and no impairment of foot function. Conclusion Using combined wrap-around flap of the big toe and tibial flap of the opposite second toe in treating degloving injuries of the thumb could achieved good appearance and function without sacrificing distal segment of the big toe. Key words: Surgical flaps; Transplantation; Microsurgery; Degloving injuries