Free toe thumb lateral pulp flap for finger pulp defect reconstruction

Purpose: The aim of this study was to report our outcomes of reconstruction using free thumb lateral pulp transfer in patients with finger pulp defects.Materials and Methods: Twelve patients (nine males and three females) who presented to our clinic with pulp defects between 2015 and 2022 were included in the study. The mean age of the patients was 34 years (range, 24–46 years). Six patients had Allen type 2, four had Allen type 3, and two had Allen type 4 injuries. Pulp defects were caused by crush injuries in nine patients and sharp instrument injuries in three patients. All patients underwent free thumb lateral pulp transfer using the same surgical technique. Patients were followed in the ward and discharged at a mean of nine days (range, 8–12 days) postoperatively.Results: None of the flaps developed total or partial loss. Venous congestion occurred in two patients. No early postoperative complications were observed in the remaining patients. One patient developed a superficial tissue infection on postoperative day 9. No donor-site complications were observed in any patient. At the final follow-up visit, only one patient had a 5° flexion contracture and a 5° flexion deficit in the distal interphalangeal joint. All other patients had a full range of motion. Sensory evaluation of the flaps was performed using the static two-point discrimination (s2PD) test and the Semmes–Weinstein monofilament (SWM) test, in comparison with the contralateral finger. The mean s2PD value of the reconstructed pulp was 4.5 mm (range, 3–8 mm), whereas it was 3 mm on the contralateral side. The mean SWM value was 3.22 g (range, 2.72–4.6 g) in the reconstructed pulp and 2.90 g on the contralateral side.Conclusion: Reconstruction of pulp defects following acute hand injuries using free thumb lateral pulp transfer yields satisfactory functional, aesthetic, and sensory outcomes.