Bilateral big toe wrap-around flap for reconstruction of the defects of the finger

Abstract

Objective To investigate the therapeutic effect of bilateral combined flap transfer in reconstruction and repairation of thumb and finger defects. Methods A partial fibular side wrap-around flap was harvested from both big toes. The flaps were tailored and designed based on measurements taken from the finger of the intact side. These two flaps were combined to reconstruct the defects of the finger. From March, 2008 to December, 2015, a total of 9 fingers (9 cases) which had defect degrees range from Ⅰ° to Ⅲ° underwent reconstruction surgeries in this way. Appearance, sensation and function of the thumb and foot flap were followed-up. Simultaneously how to improve the outcoming and success rate were explored and investigated. Results All 9 thumbs and fingers in 9 cases with these procedures were survived. No vascular crisis happened. All patients were followed up from 3 to 24 months. The reconstructed thumbs and fingers were all with abundant blood supply, having similar shape to the normal thumbs and fingers, good pain and temperature sensation, with two-point discrimination of 4-8 mm. All patients were satisfied with the thumb and finger shape, regained life and work ability as before. The donor sites had no obvious discomfort, and walking and weight-bearing function remained normal. Judged by the tentative evalution standard of function of upper limb, which was made by Chinese Medical Association for Surgery of the Hand. The results were excellent in 6, good in 2, fair in 1. Conclusion There is less damage on foot and most hand function recovery using bilateral combined flap transplantation to repair multiple fingers defect. Key words: Finger; Toe; Big toe wrap-around flap; Reconstruction; Microsurgical operation