Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China.
Department of Optometry & Ophthalmology, Wenzhou Medical University, Xueyuan West Road 270#, Wenzhou 325027, Zhejiang Province, PR China.
J Plast Reconstr Aesthet Surg. 2022 Feb;75(2):651-658. doi: 10.1016/j.bjps.2021.09.008. Epub 2021 Oct 7.
The free 1st toe hemi-pulp transfer for finger pulp reconstruction was acknowledged as the optimal one. However, the treatment of the 1st toe donor defect, owning to the impossibility of primary closure, was frequently oversimplified. This study presented a "hitchhiking" approach to resurface finger pulp and the subsequent 1st toe donor site defect in a one-stage procedure.
From 2014 to 2019, finger pulp amputations (13 digits in 12 patients) were reconstructed with free 1st toe pulp flaps, and the donor site was resurfaced by the 2nd toe pedicled flap with the 2nd toe's primary closure. Therapeutic evaluation of repaired fingers and toes was based on cold intolerance, two-point discrimination (2PD), and gait disturbance.
All finger and toe pulp flaps survived uneventfully. The average size of free 1st toe and pedicled 2nd toe flap was 3.1 cm × 2.0 cm (3.5 cm × 1.4 cm to 4.2 cm × 2.5 cm) and 3.0 cm × 1.1 cm (2.0 cm × 0.9 cm to 3.8 cm × 1.5 cm), respectively. The regained average static 2PD on the finger and 1st toe pulps was 6 mm (ranged 5-10 mm) and 4 mm (ranged 2-6 mm), respectively. All reconstructed 1st toe pulps were qualified for normal gait. One patient complained the mild cold intolerance, and hammer-toe deformities were involved in two cases.
To fulfill donor site care and cost-effective rule, the toe-to-finger pulp reconstruction can't underestimate the morbidity on 1st toe donor site due to inappropriate intervention. Equally importantly, the hitchhiking pedicled 2nd toe flap should be recruited in the reconstructive scheme.
游离第一趾趾腹皮瓣移植重建手指腹被认为是最佳选择。然而，由于无法直接缝合，第一趾供区创面的处理通常过于简单。本研究提出了一种“搭便车”的方法，即在一期手术中同时修复手指腹和随后的第一趾供区创面。
2014 年至 2019 年，我们采用游离第一趾趾腹皮瓣修复手指腹缺损 13 指（12 例），供区创面采用第二趾带蒂皮瓣修复，第二趾直接缝合。修复手指和脚趾的疗效评价基于冷感、两点辨别觉（2PD）和步态障碍。
所有手指和脚趾腹皮瓣均顺利成活。游离第一趾和带蒂第二趾皮瓣的平均大小分别为 3.1cm×2.0cm（3.5cm×1.4cm 至 4.2cm×2.5cm）和 3.0cm×1.1cm（2.0cm×0.9cm 至 3.8cm×1.5cm）。手指和第一趾腹皮瓣恢复的平均静态两点辨别觉分别为 6mm（5-10mm）和 4mm（2-6mm）。所有重建的第一趾腹皮瓣均可正常行走。1 例患者诉轻度冷感，2 例患者有锤状趾畸形。
为了满足供区处理和成本效益的原则，不能因干预不当而低估第一趾供区的发病率。同样重要的是，应在重建方案中招募“搭便车”的带蒂第二趾皮瓣。
