The Observation of the Vein Distribution of a Partial Toe-Transfer Flaps with a Short Vascular Pedicle.

Abstract

When performing partial toe-transfer flaps with a short vascular pedicle, as the flap becomes smaller, the likelihood of securing veins in the flap decreases. The purpose of this study was to clarify how frequently the partial toe-transfer flap with a short pedicle (free vascularized half-big toenail flap) contains veins and elucidate how frequently we can secure the veins with an artery via the first web space approach alone, using the Genial Viewer (a near-infrared light transmission imaging device). We observed the dorsal vein images of the bilateral big toes of 250 volunteers (male, n = 125; female, n = 125) using the device. We counted the total number of dorsal veins in the big toe, the veins that crossed the margin of the region equivalent to the half-big toenail flap, and the veins that branched off from the fibular side of the flap area. An unpaired Student's t-test was used for the statistical analyses. All of the dorsal big toes contained veins. The mean number of the veins was 2.3 (range, 1-4). Branched-off veins were observed in the area equivalent to the half-big toenail flap in 496 (99.2%) of the big toes, and the mean number of veins was 1.9 (range, 0-4). In four cases, the region contained no veins (unilaterally). Branched-off veins were observed in the first web space in 440 (88.0%) of the big toes, and the mean number of veins was 0.9 (range, 0-2). The present study indicated high consistency of the veins in partial toe-transfer flaps with a short vascular pedicle and the high possibility of harvesting a flap with only exposing the first web space. In addition, in most cases, the flap will include one or, at most, two veins in the first web space.