Finger reconstruction with a free neurovascular wrap-around flap from the big toe

From 1983 to 1998, 16 cases of finger reconstruction with a free neurovascu lar wrap-around flap from the big toe were treated. Fourteen cases were suc cessful, and two cases failed. The authors reviewed these cases on the aver age of about 38 months after surgery. Pinch power was 51 percent of the una ffected normal hand, and two-point discrimination was 7.6 mm. The mean reso rption of the grafted bone was 13 percent in width and 9 percent in length. There were no complications such as fracture of the grafted bone, nonunion , and pulp dislodgement. This procedure provided length, stability, and ade quate sensibility for a functional pinch and grasp. Sensory return to the w raparound flap on the thumb was often greater than for the same area on the opposite foot. The donor site of the wrap-around flap was acceptable, both aesthetically and functionally, and allowed the wearing of open-toed shoes by young women. Finger reconstruction with a wrap-around flap from the big toe yielded excellent cosmetic and functional results in cases involving a mputation at the level of the metacarpophalangeal joints or distal to it. I n addition, this procedure was an excellent choice for treatment in cases i nvolving avulsion injuries of the fingers and reconstruction of soft-tissue defects after tumor excision.