Multipartite Second-Toe Free Flaps for Reconstruction of Multiple Finger Defects

Multipartite second-toe Free Flaps for reconstruction of multiple finger defects.

Dong chul LEE, MD, Department of Plastic and Reconstructive surgery, Gwang-Myung Sungae General Hospital, Seoul, South Korea

 

Introduction:

I present a case series of multi-digit reconstruction using multipartite second-toe free flaps (M2TFF).

Methods:

An experience with M2TFF is presented. For each case, the injury, its reconstruction, and outcomes are described.

Results:

Case 1: A 22 years-old female pianist presented with injuries to the left hand after a motor vehicle collision. The abrasion defects were 1) the PIPJ and 2) fingertip pulp of middle finger, and 3) the ring finger nail bed. The right second toe was partitioned into three (PIP joint, toe pulp, and onycho-osteocutaneous) vascularized flaps, and each of the resulting flaps were insetted and anastomosed in the usual fashion. Five-years post operation; the patient had finished graduate studies and is a piano instructor.

Case 2: A 23 years-old female student sustained burn/press injury to the left hand. The tissue defects were of the 1) index PIPJ and 2) distal portion of little finger. The left second toe was partitioned into PIP joint and the remaining distal toe flap. The respective flaps were insetted and anastomosed. At 10-years follow up, the patient has graduated from the college and now works as an elementary school teacher.

Case 3: A four-year-old boy sustained machine injury to the right hand. The defects were 1) distal phalanx of the thumb, 2) volar soft tissue of the long finger, and 3) distal portion of the index. The right second toe was partitioned into the distal phalangeal toe and a soft-tissue bridge flap. The distal toe was planted to the distal stump of the toe, and the remaining soft tissue was bridged over the long and index fingers. At four-year follow up, the reconstructed (right) hand had developed to less than the uninjured (left) hand, but the child is able to play video games and performs his school activities without complaint.

Conclusions:

The three cases of multipartite flaps illustrate an efficient use of a single donor toe. Because a toe contains various functional units, which are pulp-for-pulp, bone-for-bone, joint-for-joint, and nail-for-nail equivalent to the finger, it is possible to use a single toe in the reconstruction of multiple finger injuries as long as these defects are not identical. As such, multipartite free flap designs are worthy considerations in reconstruction of multiple defects using a single donor organ.

Please include Images if appropriate:

Case 1)