Application of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects
Objective To evaluate the clinical efficacy of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects.Methods From January 2018 to December 2021,a total of 30 patients with thumb and finger distal segment defects were treated in our department.12 cases of thumb,2 cases of index finger,and 2 cases of middle finger distal segment defects were repaired using the fibular flap of the toe.6 cases of index finger and 3 cases of middle finger distal segment defects were repaired using the tibial flap of the second toe.5 cases of 2 or more fingers distal segment defects were repaired using a combination of the fibular flap of the toe and the tibial flap of the second toe.The routine microsurgical care after surgery was performed and the survival of the skin flap was recorded.After discharge,regular follow-up was conducted on the appearance of the skin flap,two-point discrimination of the skin flap,appearance of the nail,flexion and extension function of the finger joint,hand function score,and recovery of the foot donor area.Results All 30 skin flaps survived.At the last follow-up,the appearance of the reconstructed thumb finger was similar to that of the contralateral thumb finger,with good skin flap texture and a two-point discrimination of 3 to 10 mm on the fingertip.According to the rating of the Hand Surgery Society of the Chinese Medical Association,there were 26 cases with excellent hand function and 4 cases with good hand function.30 cases showed good flexion and extension activity of the reconstructed fingers.All cases had good healing of incisions in the foot donor area,and there was no impact on foot walking and running.All patients were satisfied with the surgical results.Conclusion The application of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects can achieve a beautiful appearance of reconstructed thumb and fingers with good sensory function,minimal damage to the foot donor area.And the advantages of the two flaps are complementary,the blood supply is the same,and the cutting method is similar.It is an ideal repair method for various types of distal segment defects of the thumb and finger.
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