Full reconstruction of IV to VI-degree finger defect

Abstract

Objective To introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect. Methods From December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows: Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger, and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.Results About half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes, and the donor wound of halluxes were covered by free flap transplantation. The second toes were reconstituted by bone transplantation from the iliac bones. All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries. Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°, and the average was 76°. Conclusion The full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex. Key words: Finger; Reconstruction; Hallux nail flap; Microsurgery