Abstract:

Objective

To explore the therapeutic effect of repairing fingertip defects with a tibial flap of the second toe of the foot using an improved vein harvesting method.

Methods

From June 2020 to June 2023， 18 cases （18 fingers） of small-area finger defects in Department of Hand Surgery， Suzhou Ruihua Orthopedics Hospital were repaired using a lateral tibial flap of the second toe of the foot with an improved vein harvesting method.Among them， there were 12 males and 6 females， aged from 22 to 56 years， with an average age of 33 years.During the surgery， a free second toe tibial flap was used to repair the wound.The flap was harvested using a modified vein harvesting method， with the flap designed to be located on the lateral tibial side of the second toe of the foot.Compared to traditional surgical methods， there was no dorsal foot incision.The lateral or bottom vein of the toe was harvested as the return vein of the flap， and the recipient area was anastomosed end-to-end with the digital artery and subcutaneous vein.The harvested area of the skin flap was from 1.5 cm×1.0 cm to 2.5 cm×1.9 cm.5 cases of skin flap donor site were directly sutured， while the rest underwent free skin grafting from the lower leg.The postoperative follow-up was evaluated using the Michigan hand function questionnaire to assess the recovery of hand function， and total active motion （TAM） was used to evaluate the recovery of finger joint range of motion.

Results

All 18 skin flaps in this group survived without any vascular crisis.Postoperative follow-up ranged from 6 months to 2 years， with an average of 13 months.3 cases had slightly bloated skin flaps and underwent flap repair surgery three months after surgery， while the remaining skin flaps did not undergo plastic surgery.The two-point discrimination of the skin flap was from 12 to 14 mm.The incisions in the foot donor area and calf healed primarily， and the skin grafts in the donor area survived smoothly without contracture or ulceration.The scars in the foot donor area were small， and there were no significant functional impairments in the foot and calf donor areas.According to the Michigan hand function questionnaire evaluation criteria， 11 patients were very satisfied with the overall appearance of their hands， and 7 patients expressed satisfaction.According to the TAM evaluation criteria for finger mobility， 18 cases were rated as excellent.

Conclusion

The clinical efficacy of repairing finger tip defects with a lateral tibial skin flap of the second toe using an improved vein harvesting method is good， with advantages such as convenient harvesting， minimal foot injury， and small scar formation in the donor area.

Key words: Finger injuries, Foot flap, Microsurgery, Improved surgical technique