Toes lateral free flap is an ideal method to repair the soft tissue defect of the finger: a single-center retrospective efficacy evaluation of 106 patients.

Abstract

Objective: To compare the clinical efficacy of transverse wrist crease perforator flap, the retrograde island flap of proper digital artery, the nutrient vascular fascial pedicled skin flap and the toes lateral free flap in the repair of finger soft tissue defects.

Methods: We reviewed the data of 106 patients with finger soft tissue defects who were admitted to Longgang District Orthopedic Hospital from January 2017 to December 2020. The patients were divided into four groups based on the treatment method: Group A (transverse wrist crease perforator flap repair group, N = 27), Group B (retrograde island flap of proper digital artery repair group, N = 23), Group C (nutrient vascular fascial pedicled skin flap repair group, N = 26) and Group D (toes lateral free flap repair group, N = 30). There was no significant difference in sex ratio, age, cause of injury, time of injury and area of defect between the four groups (P > 0.05). We compared the clinical efficacy (including total active motion, two-point discrimination, and cold intolerance), complications, and patient satisfaction.

Results: There was no significant difference in wound recovery time among the four groups (P > 0.05), and the evaluation of skin flap recovery, including color, skin temperature, elasticity, and texture, was superior in Group D compared to Groups A, B, and C (P < 0.05). After one month of follow-up, the total active activity of the affected finger was lower in Group A and Group B than in Group C and Group D (P < 0.05), while there was no significant difference in S2-PD (two-point discrimination) among the groups (P > 0.05). The results of the Cold Intolerance Symptom Severity (CISS) scale after one month of follow-up were highest in Group B, followed by Group A, Group C, and then Group D. After six months and one year follow-up, there was no significant difference in the total active activity among the 4 groups (P > 0.05), and the scores of S2-PD and CISS decreased in each group (P < 0.01). Additionally, Group D exhibited better S2-PD and cold tolerance compared to the other three groups. All patients recovered well after surgery, with one case of vascular crisis in Group A, and no complications such as joint stiffness and postoperative infection were observed in any of the groups. The results indicated that group D had the highest satisfaction level (P < 0.01), with no significant difference among Groups A, B, and C.

Conclusion: The lateral free flap from the toe is an ideal method for repairing soft tissue defects of the finger, as it effectively restores the finger's shape and skin sensation with minimal complications and a concealed donor site.