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Modified Great Toe Wraparound Flap Preserving Plantar Triangular Flap
Xiao Fang Shen, MD1; Jing Yi Mi, MD1; Harvey Chim, MD2
1Wuxi 9th People's Hospital, Wuxi, China; 2University of Miami, Miami, FL

Introduction: The traditional great toe wrap-around flap design involves preservation of a medial strip of skin. However this can be associated with wound healing problems. Here we discuss the clinical outcome of a modified great toe wrap-around flap design for thumb reconstruction.

Materials and Methods: 11 patients underwent reconstruction with a modified great toe wrap-around flap for thumb injuries with degloving of the distal phalanx. Instead of a medial skin flap, a triangular plantar skin flap is preserved (Fig. 1). The width of the flap measures 1.5 to 2.0 cm and does not extend beyond the midaxial line at its widest extent. The dorsal aspect of the great toe is covered with a skin graft. By preserving the blood supply to the plantar skin flap through the tibial neurovascular bundle, wound healing problems are reduced.

Results: All flaps survived. There were no major complications. Duration of follow-up ranged from 2 to 8 years. The contour of the reconstructed digits was the same as the contralateral one. Two-point discrimination (2PD) of digits ranged from 4 to 8 mm. The average active range of motion of the thumb interphalangeal joint was 63 2 1. There was no extensive scar formation at the donor foot. The skin-grafted area regained sensation from S2~S3+. Three patients complained of slight tenderness at the donor toe without difficulty in wearing shoes. The width of the preserved plantar triangular flap expanded 35% to 67% with nearly the same 2 PD as the contralateral one. All patients could walk, run and jump without restrictions.

Conclusions: Thumb reconstruction with a modified great toe wrap-around flap preserving a plantar triangular flap results in a thumb with excellent contour and functional outcome. Donor site morbidity in the foot is minimal.

FIGURE 1. Plantar skin flap design

FIGURE 2. Reconstructed right thumb matches the normal left thumb in size

FIGURE 3. Volar scar is well healed

FIGURE 4. Plantar flap expands over time

FIGURE 5. Dorsal skin grafted area over right toe donor site is well-tolerated

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