Combined Great Toe Dorsal Nail-Skin Flap and Medial Plantar Flap for Reconstruction of Degloved Finger Loss

Background: Historically, the degloved finger with the total loss of nails and skin had been resurfaced into two stages. Further, proximal finger amputation requires an additional bone-tendon graft and an expanded great toe wraparound flap transfer for better outcomes. The article recommends a novel strategy to address these problems in a single stage using a dorsal nail-skin flap and medial plantar artery perforator (MPAP) flap. Method: From March 2015 to June 2018, nine fingers were performed to resurface with skin loss to the metacarpophalangeal (MCP) joint level, and three amputated fingers were reconstructed with an extra bone-joint-tendon graft simultaneously. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. A standardized assessment of outcome in terms of sensory, functional, and esthetic performance was completed. Results: All flaps survived. The contour and length of the reconstructed digits were comparable with the contralateral finger. The mean static two-point discrimination was 11.0 mm (ranged, 9.0-14.0 mm). The average score of the Disabilities of the Arm, Shoulder and Hand questionnaire and Michigan Hand Outcomes Questionnaire were 2.5 (ranged,0-5) and 90.1 (ranged,82-96). The mean Foot and ankle disability index score was 95.6 (ranged, 93-99). At the last follow-up, the functional and aesthetic outcomes were satisfied for all fingers, as well as the restored sensory. Conclusion: This strategy may provide an alternative for the selected patients, seeking cosmetic resurface and functional reconstruction, preserving a weight-bearing plantar area with less morbidity. Clinical question/Level of Evidence: Therapeutic, IV