FREE TOE PULP TRANSFER FOR DIGITAL PULP R ECONSTRUCTION - REPORT ON 15 CASES

Purpose of the study The authors report their experience of digital pu lp reconstruction by free toe pulp transfer. Fifteen patients were tre ated with the lateral great toe hemipulp. Material and methods 15 case s of post-traumatic finger tip reconstruction were reviewed including 9 thumbs, 5 index, 2 medius, and one ring finger. There were 6 emergen cy cases and 9 secondary reconstructions (7 after inconvenient spontan eous healing and 2 after groin flap coverage). Results We noted 2 part ial necrosis, and 4 patients suffered from cold intolerance, The flap sensibility, according to the American Society for Hand Surgery criter ia, was excellent in 1 case good in 6 cases, fair in 7 cases and bad i n 1 case. The value of the mean two point discrimination test was 10 m m, the mean moving two points discrimination test equalled 9 mm. We ha d 1 excellent functionnal result, 6 good, 6 fair and 2 bad. The subjec tive evaluation found 12 patients satisfied and 3 disappointed. Discus sion A wide range of procedures from spontaneous healing to thenar fla p, neuro vascular flap or toe pulp transfer can be proposed to treat d igital pulp loss. In the case of moderate thumb pulp avulsion and homo digital volar flap can be proposed; if microsurgery is contra-indicate d, an hetero-digital flap from the index can be performed. When the ot her fingers are concerned, a homodigital flap can be proposed for mode rate defects. For more important trauma, the thenar flap is convenient to cover the index and the medius pulp. Ring and little fingers can b e treated by a reverse digital artery flap or by a cross finger flap.W hen a toe pulp transfer is indicated we recommend the lateral great to e hemipulp for the thumb and a second or third toe pulp transfer for t he other fingers when digital vascular anastomosis are possible. The g reat toe hemipulp transfer represented a good indication for complete digital pulp loss reconstruction when the thumb is concerned. Performi ng this reconstruction during the acute phase may improve the manageme nt of those trauma by reducing the time needed for cicatrisation and t he length of work inhability.