Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac ar-tery perforator chimeric flap

Abstract

Objective To evaluate the clinical outcome of the method of repairing donor site of foot after im-proved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator (SCIAP) chimeric flap. Meth-ods Fourteen cases of thumb defect were recruited from April, 2012 to January, 2016. According to Gu Yudong’s clas-sification, 5 cases met the criterion of type I, 4 cases met the criterion of type II, and 5 cases met the criterion of type III. For type I, the thumb was reconstructed with the great toe wrap-around flap. For type II and III, the thumb was recon-structed by the combined tissue with mutual artery (great toe wrap-around flap, and the bone-tendon tissue of the sec-ond toe). All the donor sites of foot were repaired utilizing SCIAP chimeric flap. Results All the reconstructed thumbs survived. Among 14 free flaps of donor site, 1 case suffered venous crisis and survived after exploration and rescue sur-gery. Dorsal skin necrosis of the second toe was found in 1 case, which was healed by local skin flap transposition. All pa-tients were followed-up ranged from 3 to 30 months (averaged at 16 months). In spite of slightly bloated, the color and texture of all the flaps’was satisfied, and the average healing time of the bone in the donor sites was 2.5 months. All pa-tients did not feel painful and had no adverse effect when walking and running. Three months after the operation, 5 slight-ly bloated flaps in the donor sites under went flap plastic and achieved better appearance. On the part of iliaca, there was only one inconspicuous linear scar without any discomfort. Conclusion Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method. Using this method, the reconstructed thumb can achieve good appearance and function, all the toes of donor site were reserved, and the disability of the donor site is minimized. Key words: Superficial circumflex iliac artery; Chimeric flap, perforator flap; Tissue transplantation; Thumb reconstruction; Donor site; Microsurgical technique