Reconstruction of the thumb and fingers with the second toe reshaped by the modified great toe fibular flap

Abstract

Objective To evaluate the results of thumb and finger reconstruction by transfer of the second toe reshaped by the modified great toe fibular flap. Methods The fourangle or eight-angle great toe fibular skin flap with winging form was mobilized and harvested when the second toe was transferred, and then wedged into the second toe at the plantar side. The four-angle flap was inserted into the plantar aspect of the second toe, while the winging form great toe fibular flap was inserted below the skin at the two angles. Results Eleven reconstructed thumb and fingers in 10 patients and all the great toe fibular flaps survived uneventfully. Patients were follow-up for 3 months to 12 months after the operation. The contour of the reconstructed thumb and fingers was improved, comparing to that from conventional second toe transfer. The appearance was close to that of thumb or fingers on the uninjured side. Conclusion The polygon great toe fibular flap can be wedged into the second toe to not only improve the narrow appearance at the middle portion of the second toe, but correct flexion deformity as well. Key words: Finger injuries; Surgical flaps; Microsurgery; Second toe transplantation