Microsurgical Digital Reconstruction by Vascularized Free Toe Pulp Transfer

Abstract

Background: Restoring the aesthetic appearance and sensibility of the fingers, specially the fingertip, after traumatic amputation has an essential role in the functional recovery of the hand. Advances in microsurgery have allowed better coverage of defects with low morbidity of the donor site. Purpose: Our purpose is to present the clinical and functional outcomes achieved by vascularized free toe pulp transfer for fingertip reconstruction in hand labor patients with medium to high functional demand. Method: Between March of 2011 and August of 2015, 18 patients underwent free toe pulp transfer to restore finger pulp defects. All were manual workers, 16 men and 2 women, and their average age was 39 (25-53) years. Fourteen patients suffered from traumatic partial amputations and 4 patients had high-pressure injection injury. The average time from the accident to surgery was 18 (8-30) days. Overall results were evaluated in terms of survival flap rate, complications, and additional surgical procedures. Static 2-point discrimination (s2-PD), satisfaction, and time to return to work were also assessed with a mean follow-up more than 1 year postoperatively. Results: The survival rate was 100%. Donor site required a split-thickness skin graft (STSG) in 11 cases. Good functional results and a high degree of satisfaction were obtained. Average s2-PD over the flap area was 9.1 (8-11) mm. All patients returned to heavy manual work. Conclusion: In our opinion, the use of free toe pulp transfer provides the best aesthetic and functional outcomes in digital pulp reconstruction. It provides not only a satisfactory appearance but also excellent functional results and allows patients to return to heavy manual works.