Free Toe Pulp Transfer for Digital Reconstruction

Abstract

The problem of loss pulp substance of the fingers during an unanticipated event such as trauma, represents not only the deprivation of tactile perception, but also the loss of a solid, well-cushioned covering. The ultimate goals for the reconstruction of finger pulp are to maintain the original digital length, provide adequate soft tissue padding and to obtain near-normal sensations. Anatomically and functional speaking, the most suitable source for finger pulp reconstruction will be the toe pulp. A total of 15 free toe pulp transfers were done for finger pulp reconstruction between 1992 and 2001 which included 11 thumbs, 1 index finger, 2 middle fingers, and 1 ring finger. The pulp size varied from 2.5×2 cm^2 to 4.5×2.5 cm^2. All patients were followed-up for an average of 28 months (range: 10 to 64 months). All the toe donor sites were closed with split thickness skin grafts. The survival rate of the transferred toe pulp flap was 100% in all of the 15 flaps. Partial loss of skin graft in the donor site was noted in 2 of the 15 flaps, but secondary healing was accomplished later. No discomfort was identified during maneuvers such as walking. Satisfactory functional and cosmetic results were reported in 13 of the 15 flaps. One patient had complained about the bulkiness of the transferred pulp flap. Cold intolerance of the injured digit was noted in 2 patients and two complains were about hypoesthesia of the transferred pulps. S2-PD ranged from 6 to 15 mm with an average of 9.9 mm. We believe that the free toe pulp transfer is an excellent option for the finger pulp reconstruction with minimal donor site morbidity.