Preliminary Study on Functional and Aesthetic Reconstruction by Using a Small Artery-only Free Medial Flap of the Second Toe for Fingertip Injuries

The role of great toe terminal branch artery split-thickness nail bed flaps in fingertip reconstruction surgery

BACKGROUND

The common treatments used to repair fingertip defects remain controversial. We have previously conducted research on split-thickness nail bed flaps, but this method still damages the proper plantar digital arteries and nerves. The great toe terminal branch arteries (TBAs) have not been described in detail.

METHODS

Twenty cadaveric feet were used to dissect the terminal branches of the plantar arteries. The locations and diameters of the terminal branches were analyzed. Five patients underwent operations with a TBA split-thickness nail bed flap. We recorded the recovery of both the donor and recipient sites and evaluated the results.

RESULTS

The diameter of the TBAs was between 0.4 and 0.8 mm. The TBA split-thickness nail bed flaps of five patients survived. No complications were found in any of the patients. The nail outcomes were excellent (A) in four patients and very good (B) in one patient. All patients were satisfied with the appearance of the recipient and donor sites. The mean static two-point discrimination was 6.0 mm (range, 4-9). The mean Semmes-Weinstein monofilament test score was 3.03 g (range, 1.65-3.84). Patients neither experienced severe pain in the reconstructed finger or at the donor site, nor did they experience severe cold intolerance. This microsurgical technique avoids the destruction of the proper plantar digital arteries and nerves.

CONCLUSIONS

A TBA split-thickness nail bed flap from the great toe is clinically feasible and can achieve satisfactory results in fingertip repair.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, V.

The incidence and severity of the cold intolerance after reverse homodigital dorsoradial flap for coverage of thumb tissue defect

BACKGROUND

The reverse homodigital dorsoradial flap (RHDF) has been an optional treatment for thumb soft tissue defects. The current study aims to investigate the incidence and severity of cold intolerance after the use of the RHDF for thumb soft tissue reconstruction.

METHODS

49 patients with thumb soft-tissue defects treated with RHDF from 2010 to 2018 were included with the mean follow-up time of 36 (range, 14-61) months. The assessment of sensory recovery in the flap, the Cold Intolerance Symptom Severity (CISS) questionnaire, symptoms triggering temperature grade, and natural history of the symptoms were included in the final follow-up.

RESULTS

35 out of 49 patients (71.4%) reported cold intolerance. The mean CISS score of 35 cases was 28 (range 3-72) points. The mean age of the intolerance group was significantly older than that of the non-cold intolerance group. The incidence of cold intolerance in the dorsum was significantly lower than in the pulp and tip. Significantly positive correlations were presented between CISS scores and temperature grades of symptoms triggered. Seven patients were with partial recovery while 6 patients were with complete recovery from negative symptoms. 22 patients reported no change in terms of the symptoms.

CONCLUSIONS

Cold intolerance is a common complication after the RHDF for thumb tissue reconstruction, especially in the elderly population. Cold intolerance following RHDF warrants more attention for surgeons to describe the patient expect after the procedure.

Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments

There are many outcome measures to choose from when caring for or studying fingertip and nail bed trauma and treatments. This article outlines general outcome measures principles as well as guidelines on choosing, implementing, and interpreting specific tools for these injuries. It also presents recent results from the literature for many of these measures, which can help learners, educators, and researchers by providing a clinical knowledge base and aiding study design.