Fingertip Reconstruction Using Free Toe Tissue Transfer Without Venous Anastomosis

Background This study was designed to introduce the feasibility of toe tissue transfer withoutvenous outflow for fingertip reconstruction.Methods Five cases of fingertip defects were treated successfully with this method. Four caseswere traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp ofa great toe or medioinferior portion of a second toe was used as the donor site. An arterialpedicle was dissected only within the digit and anastomosis was performed within 2 cm aroundthe defect margin. The digital nerve was repaired simultaneously. No additional dissectionof the dorsal or volar pulp vein was performed in either the donor or recipient sites. Othersurgical procedures were performed following conventional techniques. Postoperative venouscongestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation.Venous congestion was decompressed with a needle-puncture method intermittently, but didnot require continuous external bleeding for salvage.Results Venous congestion was observed in all the flaps, but improved within 3 or 4 dayspostoperatively. The flap size was from 1.5×1.5 cm2 to 2.0×3.0 cm2. The mean surgical timewas 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the firstpostoperative day, and then every 4 hours thereafter. The amount of blood loss during eachpuncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy wasobserved.Conclusions When used properly, the free toe tissue transfer without venous anastomosismethod can be a treatment option for small defects on the fingertip area.