Full-Length Finger Reconstruction for Proximal Amputation With Expanded Wraparound Great Toe Flap and Vascularized Second Toe Joint.

BACKGROUND:Most of the frequently used methods for finger reconstruction have their own limitations. Reconstruction of a full-length finger with normal appearance, in patients with proximal digital amputation, remains a challenge. METHODS:Between January 2002 and November 2013, a total of 86 fingers (60 patients) with proximal phalanx amputation were surgically repaired. A compound flap comprising an expanded wraparound flap from the great toe and a vascularized proximal interphalangeal (PIP) joint from the second toe was harvested to reconstruct a full-length finger. The flap was used to reconstruct the nail, skin, and the distal phalanx; the PIP joint was used to reconstruct the PIP joint. To attain normal length of the finger and right PIP joint positioning, an iliac bone graft was inserted into the distal-middle or proximal phalanx. RESULTS:All reconstructed fingers retained their viability and natural appearance and were of near-normal length with a normal PIP joint positioning; 12.8% (9/86) of the procedures required re-exploration owing to compromised circulation. Secondary procedures were required in 71% (61/86) of the cases. With the exception of 1 case, the donor-site complications were mild; the average range of motion at the other PIP joints was 52 degrees (-15 to -5 degrees of extension, 25-90 degrees of flexion). Approximately 80% of the normal functionality and 93% of the normal appearance with respect to aesthetics were restored. CONCLUSIONS:The full-length finger reconstruction procedure allows for construction of natural-appearing full-length fingers with normal PIP joint positioning and a near-normal functional recovery for proximal digital amputation. The operation is technically complex and time consuming and demands a skilled operator for successful outcomes.