Kusuhara Hirohisa, Sueyoshi Yu, Nagumo Yoshiaki, Asamura Shinichi, Isogai Noritaka
Department of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama, Japan.
Plast Reconstr Surg Glob Open. 2021 Feb 18;9(2):e3435. doi: 10.1097/GOX.0000000000003435. eCollection 2021 Feb.
A hemi-pulp flap is widely known as a flap useful for aesthetic and functional reconstruction of the fingers, and rarely used for toe reconstruction. We performed third toe pulp reconstruction using a free hemi-pulp flap harvested from the contralateral second toe to repair the tissue defect following toe replantation. An 18-year-old woman was injured with complete left third toe amputation and open fracture of the proximal phalanx of the left second toe in a traffic accident. On the same day, third toe replantation was urgently performed. After surgery, the third toe was partially taken, and had a toe pulp tissue defect due to necrosis. It was reconstructed with a free hemi-pulp flap prepared from the contralateral second toe. The flap was completely taken. Three years after surgery, the reconstructed left third toe was aesthetically favorable. Perception of the flap region was restored up to S2 without pain and there was no complication such as numbness, callus, and ulceration. In the flap donor site (right second toe), the skin graft was unnoticeable without pigmentation. Toe pulp reconstruction requires a sensory flap as low-invasive as possible with excellent sensory restoration, texture, feel, and shear property. This method is considered as one of the low-invasive, aesthetic, and functional reconstruction methods.
半趾腹皮瓣作为一种对手指进行美学和功能重建的有用皮瓣广为人知，而很少用于脚趾重建。我们采用从对侧第二趾获取的游离半趾腹皮瓣进行第三趾趾腹重建，以修复断趾再植后的组织缺损。一名18岁女性在交通事故中遭受左第三趾完全离断及左第二趾近节趾骨开放性骨折。当天紧急进行了第三趾再植手术。术后，第三趾部分坏死，出现趾腹组织缺损。遂采用从对侧第二趾制备的游离半趾腹皮瓣进行重建。皮瓣完全成活。术后三年，重建的左第三趾外形美观。皮瓣区域感觉恢复至S2，无痛觉，且未出现麻木、胼胝及溃疡等并发症。在皮瓣供区（右第二趾），植皮部位不明显，无色素沉着。趾腹重建需要一种尽可能微创且具有良好感觉恢复、质地、触感和抗剪切性能的感觉皮瓣。该方法被认为是一种微创、美观且功能重建的方法之一。
