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Ultrashort-Pedicle Toe Tip Transfer Assisted by Non-
Enhanced Angiography
Hidehiko Yoshimatsu, MD; Takumi Yamamoto; Mitsunaga Narushima; Takuya Iida; Isao Koshima

Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan

Introduction: With the advent of supermicrosurgery, replantation of amputated fingertips are now widely performed. However, success rate of the replantation is not 100%, especially in crush injuries in which the amputated fingertips are severely damaged. Complications of fingertip injuries, including cases reconstructed via composite grafting and local flaps, include persistent paresthesia, fingernail deformity, and cosmetic dissatisfaction. Toe tip transfer, especially with ultrashort pedicles, can address these complications, but it has not become so common owing to following reasons:

  1. Identification and dissection of donor vessels, especially veins, can be difficult.
  2. Identification and dissection of recipient veins can be challenging.
To overcome these difficulties, Non-enhanced Angiography (NEA) was used preoperatively to successfully identify appropriate veins in the donor and recipient site. In addition, the blood flow of the veins in the recipient site was confirmed via analysis of the change in hemoglobin absorption level.

Materials and Methods: Three cases of second toe tip transfer and one case of vascularized second toenail transfer were performed with preoperative examination using NEA. In all cases, the donor and recipient veins were found at the exact locations confirmed with NEA. Pedicles in all flaps were less than 1 cm in lengths. In two cases, the donor site was closed primarily, and in the other two cases, the donor site was covered with artificial dermis.

Results: Postoperative courses were uneventful, and all toe flaps survived completely, with satisfying functional and aesthetic results. No additional surgery was necessary in all cases. No complications accompanied the donor sites. In two cases where the donor site was covered with artificial dermis, secondary intention healing was completed within a month.

Conclusions: The advantages of ultrashort- pedicle toe tip transfer using NEA are as follows:

  1. NEA takes the guesswork of finding veins, especially in the dorsal aspect of the toe. This significantly facilitates the dissection of the veins in the donor site.
  2. As in the donor site, compatible veins can be found in the recipient site preoperatively, with confirmation of their blood flow.
  3. Ultrashort pedicle allows minimal dissection in the donor site, resulting in less tedious procedures and minimal invasiveness.
Although this method cannot be applied in cases with severe damage to the recipient site, we believe the preoperative use of NEA significantly facilitates ultrashort-pedicle toe tip transfer, leading to safe and less invasive surgery.
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