Cosmetic Reconstruction of Fingertips Using Free Micro-toe Tissue Flaps With Exclusive Arterial Blood Supply.

Background: Free tissue flap transfer usually requires anastomosis of both arteries and veins. However, vein repair is extremely difficult when reconstructing tiny tissues due to trauma or scar contracture in the recipient site. We describe a cosmetic reconstruction technique based on a micro-toe flap that only anastomoses arteries, challenging the typical requirement for vein anastomosis. Methods: We reported the results of fingertip cosmetic reconstruction in 13 patients with partial tissue defects of the distal finger using free-toe tissue transfer based solely on arterial blood supply. Based on the defect location and size, we designed a tissue flap of the same size from the corresponding site of the great toe. Results: The tissue flaps of all 13 patients survived. The last follow-up showed that the flap had good texture with 2-point discrimination of 4-8 mm and an average Quick Disabilities of the Arm, Shoulder and Hand score of 5.29. The tissue weight ranged from 1.6 to 5.4 g, with an average of 2.8 g. Conclusions: It is clinically safe and feasible to use free toe tissue flaps with only arterial blood supply to repair finger soft tissue defects. While maintaining surgical efficacy, the complexity of the procedure is reduced, and the duration of the operation is shortened.