Coverage of Big Toe Defects After Wraparound Flap Transfer With a Second-Toe Medial-Side Adjacent Toe Flap.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
pubmed:
16
6
2022
medline:
11
8
2022
entrez:
15
6
2022
Statut:
ppublish
Résumé
In finger reconstruction, big-toe wraparound flap (WAF) transfer provides excellent results. However, difficulty in healing and impaired function at the donor site are common. We aimed to explore an ideal method to address these complications. This retrospective study involved 22 patients who were treated with big toe WAF transfer for finger reconstruction between 2016 and 2020. Patients were categorized into cohorts by donor site repair method: second-toe medial-side adjacent toe flap and skin graft (cohort 1) and skin graft alone (cohort 2). Functional outcomes, aesthetic appearance, and complications at the donor site were compared. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) for hallux metatarsophalangeal-interphalangeal score, Foot Function Index-Verbal Rating Scales (FFI-5 pt), and visual analog scale for pain. Aesthetic appearance was evaluated according to the adjusted question 28 in the Michigan Hand Outcome Questionnaire. The mean pain scores in AOFAS and FFI-5 pt were 38.00 ± 4.22 and 3.75 ± 2.37, and 32.50 ± 4.52 and 6.60 ± 2.14 in cohorts 1 and 2, respectively, which showed no significant differences. The method in cohort 1 can reduce the level of pain. This was further confirmed by visual analog scale scores of 3.40 ± 0.84 and 6.42 ± 7.93 in cohorts 1 and 2, respectively. The mean functional scores in AOFAS and FFI-5 pt were 38.40 ± 2.37 and 1.25 ± 1.62, and 37.92 ± 2.15 and 1.56 ± 2.11 in cohorts 1 and 2, respectively, which showed no significant differences. Eight patients developed complications: 1 patient (1/10 [10%]) in cohort 1 developed a superficial infection, and in cohort 2, 7 patients (7/12, 58.30%) developed complications, including 2 short-term complications with partial necrosis and 1 delayed healing. Long-term complications included the following: scar discomfort (2 cases), pain discomfort (1 case), and skin ulceration due to repeated wear and tear (1 case). Cohort 2 had significantly more complications than cohort 1. Second-toe medial-side adjacent toe flap combined with skin graft had better aesthetic appearance, less complications, and less pain compared with skin graft alone. Hence, it can be a reliable technique for repairing the donor site after big-toe WAF transfer.
Identifiants
pubmed: 35703198
doi: 10.1097/SAP.0000000000003262
pii: 00000637-202208000-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
191-195Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Morrison WA, O'Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am . 1980;5:575–583.
Foucher G, Binhammer P. Plea to save the great toe in total thumb reconstruction. Microsurgery . 1995;16:373–376.
Dong JS, Peng YP, Zhang YX, et al. Reverse anterior tibial artery flap for reconstruction of foot donor site. Plast Reconstr Surg . 2003;112:1604–1612.
Leung PC, Ma FY. Digital reconstruction using the toe flap—report of 10 cases. J Hand Surg Am . 1982;7:366–370.
Ma ZG, Guo YJ, Yan HJ, et al. Long-term follow-up on the donor foot after thumb reconstruction using big toe wrap-around flap in two different operation methods. Indian J Surg . 2017;79:6–12.
Wei FC, Chen HC, Chuang CC, et al. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg . 1988;82:506–515.
Yuan C, Liu H, Zhang H, et al. Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg Am . 2021;46:421.e1–421.e7.
Lee JH, Alrashdan MS, Kim SG, et al. Functional and esthetic assessment of radial forearm flap donor site repaired with split thickness skin graft. Eur Arch Otorhinolaryngol . 2011;268:109–115.
Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int . 1994;15:349–353.
Kuyvenhoven MM, Gorter KJ, Zuithoff P, et al. The Foot Function Index with verbal rating scales (FFI-5pt): a clinimetric evaluation and comparison with the original FFI. J Rheumatol . 2002;29:1023–1028.
Wu SH, Liang HW, Hou WH. Reliability and validity of the Taiwan Chinese version of the Foot Function Index. J Formos Med Assoc . 2008;107:111–118.
Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am . 1998;23:575–587.
Feng SM, Gu JX, Liu HJ, et al. Treatment of distal fingertip degloving injuries using a cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. J Reconstr Microsurg . 2013;29:623–630.
Cherubino M, Corno M, Valdatta L, et al. Thumb reconstruction with thin proximal ulnar perforator free flap. J Hand Surg Am . 2017;42:e133–e138.
Morrison WA. Thumb and fingertip reconstruction by composite microvascular tissue from the toes. Hand Clin . 1992;8:537–550.
Al-Qattan OM, Almobarak AA, Al-Qattan MM. Double cross finger flaps from the middle to the index or ring finger: a case series of 4 patients with an emphasis on donor finger morbidity. Int J Surg Case Rep . 2018;45:107–111.
Kim DH, Seo KB, Lee SH, et al. Reverse digital artery cross-finger flap for reconstruction of failed finger replantation. J Orthop Surg (Hong Kong) . 2019;27:2309499018816773.
Kieselova K, Guiote V, Brinca A, et al. The cross-toe flap: an alternative method for reconstruction of digital pulp defects. Dermatol Ther . 2021;34:e14577.
Hamilton RB, O'Brien BM, Morrison WA. The cross toe flap. Br J Plast Surg . 1979;32:213–216.
Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg . 2005;21:225–229.
St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg Am . 1997;22:913–917.
Ling XF, Peng X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg . 2012;129:657–674.
Hashimoto F, Nomura S, Yamauchi S, et al. Free peroneal flap coverage of the great toe defect resulting from a wrap-around flap transfer. Microsurgery . 1986;7:199–202.
Jyoshid RB, Vardhan H, Anto F. Free medial plantar artery flap for the reconstruction of great toe pulp. J Plast Reconstr Aesthet Surg . 2014;67:863–865.