Comparison of therapeutic efficacy between second-toe tibial free flaps with plantar and dorsal veins of toe in fingertip defect reconstruction.

[OBJECTIVE] To retrospectively compare the clinical efficacy of the second-toe tibial free flap with plantar veins of the toe (modified group) versus dorsal veins of the toe (traditional group) in repairing emergency fingertip defects.

[METHODS] From March 2022 to December 2024, 60 patients (60 fingers) who underwent second-toe tibial free flap repair for digital defects were included in this study. The patients were categorised into the modified group that received second-toe tibial free flaps with plantar vein of the toe drainage and traditional group that underwent reconstruction using flaps with dorsal vein of toe drainage. Each group comprised 30 patients. Demographic data (sex and age), defect area and flap size were recorded. Postoperative outcomes included static 2-point discrimination (2-PD), total active motion (TAM), modified Vancouver Scar Scale (mVSS) for recipient and donor sites, scar on the dorsum of the foot (SDF), Michigan Hand Outcome Questionnaire (MHOQ) and flap harvesting time.

[RESULTS] No significant differences in sex, age, defect area, flap size, 2-PD, TAM, or mVSS for recipient and donor site scores were observed between the groups. Significant differences were observed in SDF, MHOQ and flap harvesting time. No complications were observed at the recipient sites in either the modified or traditional groups. However, 10 patients in the traditional group reported discomfort owing to scarring at the dorsal toe region, whereas no such discomfort occurred in the modified group.

[CONCLUSION] In emergency surgery, the second-toe tibial free flap with plantar vein of the toe demonstrated superior outcomes compared to traditional dorsal vein of the toe drainage, including minimal dorsal toe scarring, lower MHOQ scores and shorter operative time for flap harvesting.