Saturday, September 29, 2018: 9:05 AM
Bommie Florence Seo, MD, PhD
,
Department of Plastic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea, Republic of (South)
Hyuk-Joon Choi, MD
,
Plastic and Reconstructive Surgery, Catholic University, Seoul, Korea, Republic of (South)
Sung-No Jung, MD
,
Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea, Republic of (South)
Kyo Joon Kang, MDF
,
Plastic and Reconstructive Surgery, Catholic University, Seoul, Korea, Republic of (South)
Background: Transfer of great toe pulp tissue is an established procedure in reconstructing soft tissue defects of the finger, but contains risk of partial or total necrosis because it is a graft of plump composite tissue without vascular anastomosis. We have modified the procedure to increase contact surface area that has led to higher rates of survival and patient satisfaction.
Methods: Between March 2006 and March 2017, 35 patients underwent great toe pulp grafts for reconstruction of fingertip amputation. A fish-mouth incision was applied to the injured fingertip to create a wedge-shaped defect. Composite tissue from the fibular aspect of the great toe was harvested in a “watermelon slice cutting” manner to obtain a wedge-shaped volume of tissue. The wedge was then snuggly fit into the recipient, amplifying contact surface. Evaluation included total operation length, graft survival and donor site morbidity.
Results: A total of 35 patients received 37 great toe pulp grafts. 37 fingertips underwent immediate or secondary reconstruction of fingertip. Total survival was found in 36 fingertips (97.3%). Partial necrosis was observed in one fingertip (2.7%).
Conclusion: This simple wedge modification of the great toe pulp graft enhances ease of donor site closure, graft inset, and most importantly graft survival.
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