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. 2013 May;40(3):226-31.
doi: 10.5999/aps.2013.40.3.226. Epub 2013 May 16.

Second toe plantar free flap for volar tissue defects of the fingers

Yong Jin Cho  1 , Si Young Roh, Jin Soo Kim, Dong Chul Lee, Jae Won Yang
Affiliations

Second toe plantar free flap for volar tissue defects of the fingers

Yong Jin Cho et al. Arch Plast Surg. 2013 May.

Abstract

Background: The reconstruction of volar surface defects is difficult because of the special histologic nature of the tissue involved. The plantar surface is the most homologous in shape and function and could be considered the most ideal of reconstructive options in select cases of volar surface defects. In this paper, we evaluate a single institutional case series of volar tissue defects managed with second toe plantar free flaps.

Methods: A single-institution retrospective review was performed on 12 cases of reconstruction using a second toe plantar free flap. The mean age was 33 years (range, 9 to 54 years) with a male-to-female ratio of 5-to-1. The predominant mechanism was crush injury (8 cases) followed by amputations (3 cases) and a single case of burn injury. Half of the indications (6 cases) were for soft-tissue defects with the other half for scar contracture.

Results: All of the flaps survived through the follow-up period. Sensory recovery was related to the time interval between injury and reconstruction-with delayed operations portending worse outcomes. There were no postoperative complications in this series.

Conclusions: Flexion contracture is the key functional deficit of volar tissue defects. The second toe plantar free flap is the singular flap whose histology most closely matches those of the original volar tissue. In our experience, this flap is the superior reconstructive option within the specific indications dictated by the defect size and location.

Keywords: Finger injuries; Free tissue flaps; Soft tissue injuries.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Patient 1 (A, B) Volar tissue defect over middle phalanx of right ring finger. (C, D). Flap design. (E) Elevated flap (A, digital artery; N, digital nerve; D/V, dorsal vein; V, subcutaneous vein). (F) Donor site closure. (G, H) Immediate postoperative flap. (I) Reconstructed volar surface at 9-month postoperative visit. (J) Donor site at the same visit.
Fig. 2
Fig. 2
Patient 4 (A) Flexion contracture over proximal phalanx and metacarpophalangeal crease. (B) Flap design. (C) Inset flap. (D) At 7-month postoperative clinic visit.
See this image and copyright information in PMC

References

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