Composite transfer of the second toe and dorsal pedal trilobe flap for reconstruction of hand and thumb soft tissue defects

Abstract

Objective To investigate the clinical outcomes of treating irregular tissue defect of the thumb and hand with composite transfer of the second toe and dorsal pedal trilobe flap.Methods From June 2010 to March 2013,6 cases of thumb injury with various degrees of thumb defect,skin defect at the palm,dorsum and web space,and exposure of tendon,bone and neurovascular structures were treated with composite transfer of the second toe and dorsal pedal trilobe flap.Results The trilobe flaps including the lateral tarsal flap,medial tarsal flap,dorsalis pedis flap all survived uneventfully.The transferred second toes survived as well.Wounds at the donor and recipient sites all achieved primary healing.The patients were follow-up for 3 to 18 months with an average period of 8 months.The shape,color and texture of the flaps were good.Function of the reconstructed thumb was satisfactory.Weight-bearing and walking with the donor foot was not affected.There was no ulcer in the flap donor site.Conclusion Combined transfer of dorsal pedal trilobe flap based on the anterior tibial artery vascular pedicle and the second can effectively reconstruct thumb defects complicated by irregular tissue loss.This method provides sufficient tissue coverage and reliable blood supply.It complies with principles of wound repair. Key words: Microsurgery; Surgical flaps; Anterior tibial artery; Second toe; Thumb reconstruction