Abstract

RODRIGUEZ-VEGAS, José-Manuel; ROGER-DE-ONA, Ignacio; RUIZ-ALONSO, Elena  and  CAROSINI- RUIZ-DIAZ, Ramón. Microsurgical great toe pulp transfer in thumb reconstruction. Cir. plást. iberolatinoam. [online]. 2017, vol.43, suppl.1, pp.s37-s44. ISSN 1989-2055.

Background and Objective. Hemipulp transfer from the hallux provides excellent thumb reconstructions because of its high-quality soft tissue, near normal pulp contour and satisfactory sensory recovery without the need for cortical reorientation. Moreover, unlike local and regional flaps, it avoids additional damage to an already injured hand, thus optimizing the rehabilitation period and final result. The manuscript analyses the author's experience with the technique and compares it with other reconstructive options. Method. Aretrospective chart review was made of 16 patients that underwent hemipulp transfer from the hallux in the period 2007-2013. All the patients were males, with a mean age of 34 years and a high functional demand (manual workers with working injury). The technique was indicated in defects larger than 50% of the pulp surface of the thumb in otherwise healthy patients. In 3 cases, the pulp defect associated a bone defect of the distal phalanx large enough to advise a combined osteo-pulp transfer. Results. Fifteen of the 16 flaps survived without postoperative complications. A flap complicated with arterial thrombosis and had to be removed with additional coverage surgery. Except for the failed case, all the patients could return to their previous work activity with an excellent hand function. Closure of the donor area was undertaken with direct closure (12 patients) or skin graft (4 patients). None of the patients, no matter the technique of closure of the donor area, reported issues with the ambulation or aesthetic appearance of their feet. Conclusions. The reconstruction of pulp defects of the thumb with hemipulp transfer from the hallux provides excellent functional and aesthetic results. The author considers the technique to be indicated in those situations where a local/regional flap does not allow an optimal reconstruction: defects larger than 50% of the pulp surface with or without a significant defect of the distal phalanx.

Keywords : Thumb reconstruction; Toe to hand transfer; Pulp reconstruction; Hemipulp; Hand.

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