Revisional surgery for improving outward appearance of reconstructed digit in toe-to-hand transfer

Objective To present some revision surgery for correcting short and bulky outward appearance of reconstructed finger pulp in toe-to-hand transfer. Methods Since Sep. 1998 to Dec. 2006,in a series of 33 patients, 39 fingers had been reconstructed with 2nd toe. In order to change the shape of bulbous distal toe segment into a normal tapering fingertip, revisional operations had been designed, i.e. (1)Excision of bulky skin and excessive soft tissue from one or both sides of the finger pulp. (2)Transfer and inlaid the excised lateral soft tissue flap to the central constricting part of the finger pulp. (3)Full thickness skin graft to palmar central narrow part of toe pulp. 4. Rotational transfer of local lateral "L" shape flap. Results All the patients healed by first intention with no skin necrosis occurred. The bulbous rectangular shaped toe pulp were corrected and outward appearance were much improved in most cases. Though the outward appearance in one simple skin graft case was not satisfactory in correcting flexion deformity of distal segment and increased its circumference. Conclusion In toe-to-hand transfer, the distal segment of reconstructed finger often shown to have an bulbous toe pulp appearance, which may bring psychological burden to the patient and their relatives. Simple revisional surgery recommended here may yield favorable improvement. Key words: Toe;  Finger;  Reconstruction;  Transplantation;  Microsurgical technigue