Anatomical Study On The Fibular Side Flap Of The Second Toe And The Application In Cutaneous Deficiency Treatment Of The Hand

Background: Free skin flap is an important method for manus cutaneous deficiency treatment and the skin flaps from feet are most frequently used with satisfying results as its color, quality and elasticity are similar to those of manus. However, people found that flaps like dorsum pedis skin flap, great toe skin flap, the great toe fibular skin flap, which sacrificed the some principal blood vessel like dorsalis pedis or dorsal metatarsal artery, could bring many complications to the donator foot. With the advances in microsurgery anatomy and the improvements of manus surgery techniques, skin flaps that don't do harm to principal arteries have been introduced to clinic but there hasn't been a report on application of fibula side flap of the second toe in manus cutaneous deficiency treatment.Objective: To study the diameter of vessels and nerves that related to the fibula side flap of the second toe, the dimension of the flap and its possibility, advantages, disadvantages, application and announcements in clinic.Method: 10 left feet and 10 right feet from newly dead adults were obtained and red lacteprene was instilled through dorsalis pedis artery. After that, the feet were dissected, the dimension of lacteprene was measured and the diameter of fibular intrinsic artery, fibular dorsal digital arteries, dorsal digital veins of foot, digital intrinsic arteries anddorsal digital nerves of foot of the flap and the second dorsal metatarsal artery and dorsal metatarsal veins that closely related to the flaps. In clinic, 17 patients with finger cutaneous deficiency received the treatment of fibula side flap of the second toe with observation like flap survival rate, infection, necrosis, appearance and function.Results: Filling by lacteprene, after dissection we found: perfusates can reach 6mm X 8mm dorsal interspace back skin between the second and third metatarsal bone; we measured the diameter of blood vessels and nerves near the second metatarsophalangeal joint,as follow:the second dorsal metatarsal artery (1. 8+0. 2) mm, the second dorsal metatarsal vein(l. 4+0. 2)mm, the second basic-metatarsus artery(1. 5+0. 2) mm, the second dactylo-fibular proper artery (1. 0 +0.2) mm, the second dorsal digital artery (0. 7+0. 2) mm, the second dorsal digital vein ( 0.9 + 0.2 ) mm , the second dactylo-fibular proper nerve and dorsal digital nerve of foot(1.4+0. 2)mnu (0. 5+0. 2) mm0To the 17 patients, all the flaps survived and there wasn't infection seen. All the wounds on finger were confirmed to be primary healing except that the fingertip of one patient was cut off because of severe crush injury and one patient had got necrosis on the grafted skin on foot, which was cured by continuous dressing change. After 4 months of follow-up, grafted flaps presented good appearance with basically normal sensation and satisfying functional restoration. What's more, no complication of the foot, like lameness or pain, was observed.Conclusion: Fibula side flap of the second toe was suitable for manus cutaneous deficiency treatment as it provided stable blood supply, had appropriate vessels for anastomosis, the quanlity and appearance were nice and had little influence on the donator foot.