Partial Second Toe Pulp Free Flap for Fingertip Reconstruction

Abstract

The authors present their clinical experience and surgical methods of fingertip coverage using a short-pedicle partial medial second toe pulp free flap. The surgical steps for reducing surgical time and donor-site morbidity are described. Between April of 1999 and September of 2006, 929 partial second toe pulp free flaps were performed in 854 patients. The indications for this flap were preservation of digital length to cover exposed bone and replacement of skin over unstable fingertip scars. A total of 156 patients were assessed more than 1 year postoperatively with the two-point discrimination test. The mean patient age was 34 years (range, 20 months to 72 years); 747 of 854 were male. The overall survival rate was 99.7 percent. Fifty-seven patients had two fingertip defects covered with bilateral second toe pulp flaps and nine had three defects covered with bilateral second toe pulp flaps and a third toe pulp flap. Donor-site complications occurred in 59 cases (hematoma, n = 39; wound separation, n = 20). No gait disturbance or painful toes were observed at the donor site. Static two-point discrimination averaged 8 mm (range, 4 to 15 mm). A total of 264 patients required additional surgical procedures, including skin grafting at the recipient site (n = 154) and secondary flap revision (n = 110). The shorter pedicle and smaller flap can reduce the surgical time and morbidity associated with this procedure. This flap is the authors' first line of treatment for covering fingertip wounds by transferring similar pulp tissue from the toe to the finger.