Finger Tip Reconstruction Using Great-Toe-Pulp Free Flap

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Journal of the Korean Society for Surgery of the Hand 2007;12(4):195-199.
Published online December 1, 2007.

Choon Sung Park, Jong Jin Kim, Ji Hyun Moon, Nae Ho Lee, Kyung Moo Yang

제 1 족지 수질부 유리피판술을 이용한 수지첨부의 재건

박춘성, 김종진, 문지현, 이내호, 양경무

Abstract

Purpose
The reconstruction of post-traumatic finger tip requires adequate soft tissue coverage, near normal sensibility without pain and minimal donor site morbidity. Local flap coverage is popular but can result in a functional limitation at the donor site. And local flap cover is usually impossible if tissue loss is over about 2 cm2. Also other regional or distant flap coverage have some limitation. Small free flaps though complex, may provide a superior alternative. Material and Methods: We reviewed 16 patients who were treated with great-toe-pulp free flap from Jan. 2002 to Dec. 2006. Mean age was 32 years old (19~47 years old). There were 12 men and 4 women. The fingers covered with flaps were 6 thumbs, 4 index and 6 long fingers. Objective sensory recovery was assessed with static two-point discrimination and Semmes-Weinstein monofilament tests. Results: The results of static two-point discrimination test were 6~10 mm in 5 cases, over 10 mm in 11 cases and the those of Semmes-Weinstein test were 3.22~3.61 in 6 cases, 3.84~4.31 in 10 cases. Subjective evaluation found in 16 patients were satisfactory with function and aesthetics, minimal pain or limitations in motion. Five patients whose recipients sites were developed cold intolerance but gradually diminished. Conclusion: Great-toe-pulp free flap restored the sensibility, stability and durability of the finger pulp and achieved functional recovery of the traumatized finger tip. Toe-pulp free flap is a safe and reliable procedure in case of limited indication and careful preoperative evaluation.

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