Plantar perforator flap based on the tibial digital artery of the second toe to reversely repair the donor site wound of the great toe fibular flap

Zhang Manying; Zhang Wei; Cheng Yizhao; Liang Gaofeng; Zhao Linlong; Ten Yunsheng; Guo Yongming

doi:10.3969/j.issn.1009-4237.2026.02.006

Abstract：Objective To investigate the feasibility and clinical efficacy of the reverse repair of the donor site of the great toe fibular flap with the plantar perforator flap based on the tibial digital artery of the second toe.Methods From Apr.2021 to Dec.2023,clinical data of 18 patients whose donor site wound of the great toe fibular flapwere reversely repaired with the plantar perforator flap based on the tibial digital artery of the second toe in our department were retrospectively analyzed.Among them,there were 14 males and 4 females;the mean age was 40.8(range,27-56)years.The operation time was 157-236 min,mean 175 min.There were 4 thumb,6 index,5 middle and 3 ring finger injuries.After reconstruction of the fingers with fibular flaps of the great toe,the soft tissue defects at the donor sites measured 1.6 cm×2.8 cm to 2.4 cm×3.2 cm.Plantar perforator flaps based on the tibial digital artery of the second toe were used to repair the donor site wound of the great toe,harvested at a size of 1.8 cm×2.9 cm to 2.5 cm×3.4 cm.All the donor sites of the second toe were closed directly.Results All the plantar perfora-tor flaps of the second toes survived successfully.The mean follow-up time was 19.7(range,13-28)months.The texture and color of the flaps were close to the surrounding skins.The walking and activity functions of the first and second toe joints were not obviously affected.The reconstructed finger pulp was full,with good appearance and an average Vancouver scar scale score of 0.3.The plantar perforator flaps based on the tibial artery of the second toe showed soft texture,without ulceration or bloated appearance.Wearing shoes or walking function was not affected.Patients were satisfied with the appearance and function of their hands and feet.Conclusion Reverse repair of the fibular flap of the great toe with plantar perforator flaps based on the tibial digital artery of the second toe showed small donor site damage,good texture matching and wear resistance,reliable blood supply,direct suture of the donor site,and postoperative aesthetics,being a good choice to repair the donor site of the fibular flap of the great toe.