Comprehensive reconstruction of gradeⅠ-Ⅱdigital defects with hallux osteo-onychocutaneous flap of great toe: a report of 9 cases
10.3760/cma.j.cn441206-20250210-00031
- VernacularTitle:甲骨皮瓣全形再造修复Ⅰ~Ⅱ度指缺损9例
- Author:
Gangyi LIU
1
;
Jie ZHANG
1
;
Weichao YANG
1
;
Chunxu WANG
1
;
Jianmei LI
1
;
Chunlong XI
1
;
Xiaoni LI
1
;
Yalan YAN
1
;
Zhimin ZHANG
1
Author Information
1. 宝鸡第三医院手显微外科,宝鸡 721000
- Publication Type:Journal Article
- Keywords:
Digital defect;
Hallux osteo-onychocutaneous flap of great toe;
Great toe;
Comprehensive reconstruction;
Microsurgical technique
- From:
Chinese Journal of Microsurgery
2025;48(4):388-393
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.
