Free second toe flap to reconstruct the thumb of grade Ⅲ or Ⅳ defects
Zhao Lei
Yang Chenyi
Yang Qiang
Zhong Yunbin
Abstract：Objective To explore the clinical application effect of free second toe flap for reconstruction of thumb grade Ⅲ or IV defects.Methods From Feb.2020 to Feb.2023,12 patients with thumb grade Ⅲ or IV de-fects admitted to the Second Department of Orthopedics in Luzhou Hospital of Traditional Chinese Medicine were in-cluded,who underwent transplantation reconstruction with the second toe.There were 5 males and 7 females aged 35-55(mean 40.5)years.Among them,8 were caused by mechanical injuries and 4 by traffic accidents,with 5 ca-ses of grade Ⅲ and 7 grade IV defects.All the 12 patients underwent elective surgery.Regular follow-up was car-ried out at the outpatient clinics or via WeChat,for the overall appearance of the thumb,appearance of the fingernail,sensation of the fingertip pulp,opposition function,and condition of the scar.Results The reconstructed thumb successfully survived in 11 cases and failed in 1 case due to arterial embolism who received residual limb stump trimming surgery.All patients were followed up for 2-13 months,with an average period of 10.5 months.During the follow-up,no complication such as deformity or pain of the reconstructed thumb was observed.The appearance of the reconstructed thumb was roughly similar to that of the healthy side,with fair opposition function;2 cases showed skin pigmentation around the wound.According to the function criteria by the Hand Surgery Society of the Chinese Medi-cal Association,8 cases were rated as excellent,2 good and 1 fair.According to the standard of the Medical Re-search Council of the United Kingdom,the sensation of the fingertip pulp all recovered to S3+.The average score of the foot donor site using the Vancouver Scar Scale was 1.5±0.8.Conclusion During the surgery of free and trans-plantation of the second toe to reconstruct the thumb of grade Ⅲ or Ⅳ defects,the sacrifice of the second toe does not affect the weight-bearing function of the foot.This surgery restores the overall appearance,sensation,opposition function,and tip-to-tip pinch function of the thumb,presenting with satisfactory clinical efficacy.
Keywords：Hand and foot injuriesThumb defectThumb reconstructionSecond toeToe transplanta-tion
Publication Date：2025-07-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 504-507 )