The Anatomy And Clinical Application Of C-Shaped Flap From Big Toe

Background: Segmental or ring form soft tissue defect is a commom finger tip injury in hand surgery clinically. It mainly refers to segmental or ring forum defect of soft tissue in the proximal part of finger. Cause of injury includes cutting,crushing,cracking,mutilation and ect. It is very commom in the clinical work of hand surgery, In treatment of segmental or ring form defect, patient's traumatic condition, age, and occupation desire should be considered. There are diverse treatment methods of treating segmental or ring form defect on the finger, such as①conservative treatment for per secundum intentionem;②in situ suture of the mutilated tissue;③free skingrafting (full thick skin graft or free skin graft with subdermal vascular plexus )④transplantation of complex tissue from digitis.⑤direct suture after phalangeal bone being shortened.⑥skin flap transplangtation. In general, there are some principles for different kinds of segmental or ring form defect of finger, but any of the mode is not definitive.Clinically, there are about 1/3 of finger tip injury need skin flap reparation. Indications of skin flap reparation including:①remaining lenghth of the finger is very important, such as thumb.②There is exposing of deep tissue , such as bones and tendons and etc. Relationship between skin flap and injury fingercan be divided into 3 kinds listed below.(1)regional flap: It is obtained from the injuried finger, having various category and improving methods , easy to be dissected and little injury to donor site. (2)Periposition flap on hands: It is obtained from injury hand except the injury finger, It can be use to repair large area injury on finger tip. Somtimes,in reparation with some kinds of flaps, such as cross finger flap,thenar flap and vascular nervous islet flap in different fingers and so on, there are large injury to the donor site.(3)Distant skin flap: Since it is obtained from place except the injury hand, it needs compulsive position crossing fixation and cutting the pedicel in second stage, such as femoris fissure flap,subclavicular flap,rump flap and so on.C-shaped flap from big toe is a kind of important method for repairing digital segmental or ring form defect with distant skin flap. Although large amount of work has been done in clinical and basic study of C-shaped flap from big toe, only some words, schematic diagrams, or rough clinical pictures have been left, steric and macrocopic anatomic evidences are still very deficient.Objective: To introduce anatomic structure and clinical application of repairing ring form digital defect with C-shaped reverse fascial pedicled island flap from tig toe.Methods: C-shaped flap was designed on proximal part of the big toe. By using digital artery as fascial pedicle and transplanting corresponding skin, blood vessels, tendons and bones, digital tissue defect was repaired.Results: In clinical application, C-shaped flap was found to have advantages of fine survival, satisfactory appearance, good sensory and motor function reconstruction of the recipient site. At the same time, by repairing donor site defect with grafted skin, satisfactory appearance and function of the donor site could also be obtained. Only obscure scars can be found on both donor and recipient site.Conclusion: Having advantages of extended skin paddle and aversatile pivot point on the phalanx, C-shaped flap from the big toe can restore original function and appearance of the injured finger. Therefore, this kind of flap can be an ideal method in repairing segmental and ring form digital tissue defects.