The authors report their modification of the great toe wrap-around flap to cover degloved digits. The problems identified with standard flap coverage include cosmesis, the absence of a nail, insensibility, and bulkiness of the reconstruction. In an effort to improve these results, the authors employ a wrap-around toe flap. The difficulty with the standard wrap-around toe flap is a general lack of adequate soft tissue within the flap for complete digit coverage. Their modification to help correct this involves the harvest of the standard great-toe wrap around flap with inclusion of the medial skin flap from the adjacent second toe within the same pedicle. The 2nd web space on the plantar surface is not violated. This adjacent skin flap can then be used to help cover deficient areas.
The authors covered 10 fingers in 7 cases over a 5-year period with follow-up ranging from 3-5 years. No complete flap losses were observed, but 2 patients experienced partial or marginal flap necrosis. Five of 7 patients had good or excellent nail plate appearance with 1 partial necrosis and 1 case of atrophy. Active MCP motion varied from 60-80 degrees, and PIP motion varied from 40-70 degrees (mean of 50 degrees). Two-point discrimination ranged from 8-12 mm and 6 of 7 patients rated their satisfaction as “good” and 1 as “fair.”
Coverage of digits avulsed from their soft-tissue cover which is not replantable is a difficult problem for which many solutions exist. All provide lack-luster results. This article provides an additional solution which may improve somewhat upon the cosmetic outcome and functional aspect in terms of a nail complex and return of protective sensation with acceptable but a not normal cosmetic result.