Reconstruction of Thumb Pulp Defects Using Free Lateral Great Toe Flaps.

[PURPOSE] To evaluate the risk factors for, and clinical outcomes of, free lateral great toe flaps for the reconstruction of thumb pulp defects.

[METHODS] Between January 2009 and July 2017, 31 patients with thumb pulp defects were treated with free lateral great toe flaps. Seven patients were lost to follow-up. We included 9 female and 15 male patients, average age 35 years. We performed a retrospective review of risk factors, clinical outcomes, and complications. For patients in which the flap survived, we assessed postoperative range of motion, static 2-point discrimination, Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire, time of return to work, and cold intolerance severity score.

[RESULTS] Of 24 flaps, 20 survived completely. Smoking was found to be a potential risk factor for flap necrosis. Average follow-up of the 20 patients in whom the flap survived was 20 months (range, 12-24 months). At final follow-up, all patients were satisfied with recovery in terms of function and aesthetic appearance. No patient required additional aesthetic refinement procedures. Complications occurred in 6 patients and consisted of venous congestion, superficial infection, and deep infection.

[CONCLUSIONS] Lateral great toe flap transfer in the reconstruction of thumb pulp defects has proven to be a good technique with overall satisfactory outcomes. Smoking increases the risk for flap necrosis.

[TYPE OF STUDY/LEVEL OF EVIDENCE] Therapeutic IV.