Versatility of a second toe plantar flap.

A second toe plantar flap was first reported about ten years ago as a useful small neurocutaneous flap for reconstruction of fingertip defects. Since that time, a satisfactory follow-up report on this noteworthy procedure has not yet appeared. In this article, the advantages and potentialities of the flap are discussed along with the pitfalls of clinical application. Two types of reconstruction have been performed using this flap during the past eight years. One type, which has been used in 12 cases, involves combination with an onychocutaneous flap. The other type, which has been used in 15 cases, involves sole transfers to distal digital defects or secondary defects of the palmer side of the digits after releasing the contracture, which is assessed functionally and esthetically. Thirteen of these 27 reconstructions were conducted uneventfully; however, two cases of arterial insufficiency at the donor toe were experienced. Functional and esthetic evaluations of these thirteen cases were almost acceptable, and the donor toe complication was also considered to be a minimum adverse effect. This flap is suitable for not only a distal palmer defect, but also variously shaped skin defects of the digits with minimum donor site morbidity; however, the possibility of arterial insufficiency of the pedicle should be borne in mind.