RESURFACING OF THE DONOR DEFECT AFTER WRAP-AROUND TOE TRANSFER WITH AFREE LATERAL FOREARM FLAP

In thumb reconstruction, the wrap-around free flap has many advantages ; however, delayed wound healing, pain, and skin ulcerations al the do nor site can be a problem. In 5 patients, a free lateral forearm fasci ocutaneous flap was successfully used for immediate resurfacing of the donor defect of the big toe during wrap-around procedures. This flap was selected after preliminary anatomic studies that showed that it co uld be safely raised if based on the anterior terminal division of the posterior radial collateral artery. The average follow-up period was 2 years. The time required for healing of the great-toe defect was les s than 1 month. All patients were satisfied with the outcome of the pr ocedure. The skin of this flap is very pliable and thin, and the subcu taneous tissue is about half the thickness of that of the lateral arm flap. This technique is especially indicated for closure of moderate t o big skin defects at the great-toe level, whenever a larger than usua l amount of skin is required, during wrap-around procedures for thumb reconstruction.