Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer |
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Authors: | Leyi Cai Xian Zhang Yingying Zhang Guangheng Xiang Peng Luo Zhijie Li Feiya Zhou |
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Institution: | 1.
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children''s Hospital of Wenzhou Medical University, Wenzhou
China
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2.
Department of Operation Care Unit, The Second Affiliated Hospital and Yuying Children''s Hospital of Wenzhou Medical University, Wenzhou
China |
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Abstract: | Objective Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Methods Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia. Results All donor site wounds healed well. The average follow-up time was 23.6 months (6–39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Conclusions Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger. |
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Keywords: | Digitsoft Tissue Defect Surgical Flap Toenail Flap |
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