Reconstruction of fully shaped fingers using a free great toe nail flap combined with a second toe tissue flap

Abstract

To explore the clinical outcome of a free great toe nail flap (GTNF) combined with a second toe tissue flap (STTF) for fully shaped finger reconstruction (FSFR). From January 2013 to January 20, 2019, patients with finger defects underwent finger reconstruction using free GTNF combined with an STTF. All 20 fully shaped, reconstructed fingers survived without complications. The average follow-up time was 44.4 months (range 12-60 months). The reconstructed fingers had better function and appearance. The length of the fingers was close to normal, and the joint positions were normal. The fingers were able to extend -15° to -5° and flex 40° to 85°. The reconstructed fingers had no pain or numbness, and the function of the feet was restored well. The reconstruction of fully shaped fingers using GTNF combined with an STTF results in better function and appearance. This surgical method is worthy of promotion. This article introduces a new surgical method that is related to finger reconstruction. Finger defects bring psychological and functional regrets to patients and their families. Through this operation, the reconstructed finger is more perfect in appearance and function. I think this technology is very effective and worth promoting.

Keywords: finger; free transplantation; fully shaped reconstruction; great toe nail flap; second toe.

FIGURE 1

Design of the skin flap on the donor foot: nail flap designed on the back of the toe and on the sole of the foot and interphalangeal joint marked on the second toe

FIGURE 2

Image A shows the dorsal foot, dorsal metatarsal, and dorsal toe arteries and veins. Image B shows plantar nerves and tendons. Image C shows the cut in the middle of the metatarsal bone and the second interphalangeal joint

FIGURE 3

The great toe nail flap is on the left, including the toenail and the distal phalanx, the dorsal metatarsal artery vein, and the great toe fibular side artery nerves. On the right is the second interphalangeal joint, the second toe tibial side artery nerves, and the flexor and extensor toe tendons. The middle artery is an anastomosis of the fibular side artery of the great toe and the tibial side artery of the second toe

FIGURE 4

The top two images are postoperative photographs, the bottom left is a photograph of the donor foot, and the bottom right is a photograph of a patient shaking hands

FIGURE 5

The upper two photographs were taken 2 years after thumb reconstruction; the middle three photographs were taken 3 years after thumb reconstruction upon re‐examination, including both hand and donor site images; and the lower two photographs show that the right hand can write normally and pick up a teacup

FIGURE 6

(A) 1 Dorsal metatarsal artery, 2 Hallux transverse artery, 3 Second toe tibial side artery, 4 Hallux fibular side artery, 5 Dorsal foot vein. (B) 1 Artery in the sole of the first toe, 2 Nerve in the sole of the first toe, 3 Intersection of the hallux fibular side artery and second toe tibial side artery