Reconstruction of Thumb Pulp Defects Using Free Lateral Great Toe Flaps.

PURPOSE: To evaluate the risk factors for, and clinical outcomes of, free lateral great toe flaps for the reconstruction of thumb pulp defects.

METHODS

Between January 2009 and July 2017, 31 patients with thumb pulp defects were treated with free lateral great toe flaps. Seven patients were lost to follow-up. We included 9 female and 15 male patients, average age 35 years. We performed a retrospective review of risk factors, clinical outcomes, and complications. For patients in which the flap survived, we assessed postoperative range of motion, static 2-point discrimination, Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire, time of return to work, and cold intolerance severity score.

RESULTS

Of 24 flaps, 20 survived completely. Smoking was found to be a potential risk factor for flap necrosis. Average follow-up of the 20 patients in whom the flap survived was 20 months (range, 12-24 months). At final follow-up, all patients were satisfied with recovery in terms of function and aesthetic appearance. No patient required additional aesthetic refinement procedures. Complications occurred in 6 patients and consisted of venous congestion, superficial infection, and deep infection.

CONCLUSIONS

Lateral great toe flap transfer in the reconstruction of thumb pulp defects has proven to be a good technique with overall satisfactory outcomes. Smoking increases the risk for flap necrosis.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.