Francisco del Piñal, M.D., Dr. Med.

ASSH Surgical Anatomy: Flap Reconstruction chapter 43 313-320, 2018. Edited by Kevin C. Chung, MD, MS and Steven L. Moran, MD – Copyright © 2018 American Society for Surgery of the Hand (ASSH)

INTRODUCTORY PARAGRAPH (full text pdf. below)

Neurocutaneous Toe Free Flap with Pulp

Soft tissue reconstruction of the fingers poses a reconstructive challenge when there may be a need for glabrous skin and/or nerve and/or arterial inflow. A partial toe transplant permits a one-stage solution for complex losses of a digit in an unprecedented way as compared to any nonmicrovascular method. Various compound flaps can be harvested from the toe, and rarely does the donor toe need to be sacrificed (Fig. 43-1). The main drawback that limits the widespread use of these flaps lies in the fact that familiarity with vessel handling in the ultra-microsurgery (0.5 mm or less) range is required. Although many surgeons avoid this procedure, it is quite safe; in my practice, the survival rate for toe transfers is 99.3% of 450 procedures.