Combined transfer ot the second toe and tibial digital artery flap from the third toe to improve appearance of the reconstructed finger

Objective To introduce a modified second toe-to-hand transfer procedure combined with a tibial digital artery flap from the third toe to correct the defects in appearance after toe-to-hand transfer due to the difference in natural shape between the second toe and the finger.Methods Nine patients with 10 thumb or finger defects were treated with the modified procedure.In reconstructing a finger or thumb with second toe transfer,a flap from the tibial side of the third toe was designed and transferred to the plantar side of the donor second toe in order to obliterate the constriction below the toe pulp.This flap shared a common blood supply with the second toe.Results All the reconstructed thumbs and fingers survived.The 6 to 8 mm increase in the circumferential at the mid-portion of the newly reconstructed fingers greatly improved the appearance of the fingers.Conclusion The tibial digital artery flap from the third toe has a constant vascular supply and adequate flap thickness.Flap harvest is straightforward and can be done simultaneously when harvesting the second toe.The flap corrects the shape of the second toe while combined with second toe-to-hand transfer for thumb or finger reconstruction. Key words: Finger injuries;  Tissue transplantation; Microsurgery