[Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery]

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.