Troisi Luigi, Stucchi Sara, Vizcay Macarena, Zanchetta Francesco, Baez Antonio, Parjardi Eugenio Eugenio
Reconstructive Microsurgery Service, University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy.
School of Specialization in Plastic, Reconstructive and Aesthetic Surgery, University of Milan, Milan, Italy.
Plast Reconstr Surg Glob Open. 2022 Sep 30;10(9):e4539. doi: 10.1097/GOX.0000000000004539. eCollection 2022 Sep.
Since its inception, the great toe pulp (GTP) flap has represented a valid therapeutic choice in the reconstruction of defects of the hand. This study illustrates the clinical outcomes of GTP free flaps performed without nerve anastomosis' mainly for fingertip defect reconstruction.
We performed a retrospective, monocentric cohort study. All patients included in this study presented with fingertip traumatic injury, with tendon or bone exposure; reconstruction with GTP flap, without nerve reconstruction, was performed by the first author (L.T.) from May 2019 to October 2021.
All 37 flaps survived completely. Due to COVID restrictions' we had to send the tests and PROMs to our patients; 28 of them replied. Cold intolerance was reported by 12 patients (moderate in two cases and mild in ten cases). No pain was complained about either in hand or donor site (Visual Analog Score 0, at rest and at movement). Complete range of motion was achieved in 22 of 28 patients. All flaps recovered protective sensitivity. In every section of the Michigan Hand Outcome Questionnaire, all patients expressed a high level of satisfaction based on the reconstruction's function and aesthetics. Regarding the donor site morbidity, no patient complained about gait disturbance.
This study showed that the GTP flap is the optimal choice for fingertip reconstruction, providing excellent functional and aesthetic results with durable and glabrous skin, satisfactory pulp contour, and sensory restoration. These results could be achieved with no need for nerve suture, especially in defects with no injuries proximal to the loss of substance.
自问世以来，拇趾腹皮瓣一直是手部缺损重建的有效治疗选择。本研究阐述了主要用于指尖缺损重建的无神经吻合游离拇趾腹皮瓣的临床疗效。
我们进行了一项回顾性单中心队列研究。本研究纳入的所有患者均为指尖创伤性损伤，伴有肌腱或骨质外露；2019年5月至2021年10月，第一作者（L.T.）采用拇趾腹皮瓣进行重建，未进行神经重建。
所有37例皮瓣均完全存活。由于新冠疫情限制，我们不得不将检查和患者报告结局量表发送给患者；其中28例患者进行了回复。12例患者报告有冷不耐受（2例为中度，10例为轻度）。手部或供区均无疼痛主诉（静息和活动时视觉模拟评分为0）。28例患者中有22例实现了全关节活动度。所有皮瓣均恢复了保护性感觉。在密歇根手功能结果问卷的各个部分，所有患者基于重建的功能和美观度均表示高度满意。关于供区并发症，没有患者抱怨步态障碍。
本研究表明，拇趾腹皮瓣是指尖重建的最佳选择，可提供优异的功能和美观效果，皮肤持久光滑，指腹轮廓满意，感觉恢复良好。无需进行神经缝合即可取得这些结果，尤其是在缺损部位近端无损伤的情况下。
