gms | German Medical Science

Objectives/Interrogation: Traumatic digit amputations could compromise pinch and grasp functions of the digits. Combination foot flaps for digit reconstruction was previously introduced by our group as an alternative method for toe-to-hand transfer [1]. The aim of this study was to analyze our experience with the combination foot flaps and to present the surgical refinements that were introduced.

Methods: Between 2009 and November 2017 a total of 37 combined flap digit reconstructions were performed on 37 patients with a median follow-up of 27.4 months (range 11 - 78). Of the 37 combined flap digit reconstructions, thumbs were reconstructed in 23 patients, index fingers in 8 patients, middle fingers in 3 patients, ring fingers in 2 patients and small finger in one patient. 21 combination flaps were based on one pedicle while the others were on two pedicles (Finger 1). 12 cases were done in the first stage and the remaining 25 in the second stage. The median operation times were 6.7 (range 3.5 - 13) hours.

Results and Conclusions: The shape and size of the reconstructed thumbs or fingers were comparable to the corresponding thumb and fingers on the uninjured side, except for two, which required debulking. The MHQ score of the repaired hand was 80.3 ± 5.2 points. The sensation of the reconstructed digital pulp was 10.0 ± 3.1 points. Partial necrosis occurred in three flaps (4.1%). Two palmar flaps (2.7%) were bulky. Contracture of first web occurred in two cases (2.7%). Wound dehiscence of donor site was observed in three patients (8.1%). Toe nail deformity occurred in one case (2.7%).The combination foot flap is a good option for digit reconstruction with minimal donor-site complications.