Reconstruction of Allen's type IV fingertip amputation via bilateral unequal-sized hallux osteo-onychocutaneous free flaps:A retrospective study with 5-year follow-up

Purpose:The reconstruction of Allen''s type IV fingertip amputation is a clinical challenge.Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen''s type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique.Methods:A retrospective analysis with a 5-year follow-up including 13 patients with Allen''s type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted.The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps.The operation time,intraoperative blood loss,and complications were recorded,and the survival rate of the transplanted flaps was calculated.During the 5-year follow-up after operation,the nail growth time was recorded and the finger appearance was observed.At the last follow-up appointment,the length,width,and girth of the reconstructed fingertip and contralateral normal fingertip,range of motion of the reconstructed fingertip and contralateral normal fingertip,Semmes-Weinstein test(for the evaluation of tactile sensation),and two-point discrimination testing results were recorded.SPSS 22.0 software was used for the statistical analysis and the data are presented as mean±SD.Results:The mean operation time was(5.62±0.51)h,the mean intraoperative blood loss was(34.15±3.13)mL,and the survival rate of the transplanted flaps was 100%.During the 5-year follow-up,the average nail growth time was(10.14±1.98)months and the average bone union time was(3.78±0.91)months.The length,width,and girth of the reconstructed fingertip were(31.52±3.73)mm,(17.82±1.74)mm,and(59.75±3.04)mm,respectively,which did not differ from those of the contralateral normal fingertip.The range of motion of the reconstructed fingertip was(12.15±2.79)degrees which is different from that of the contralateral normal fingertip.The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were(0.39±0.17)g and(7.46±1.14)mm,respectively,which were not different from those of the contralateral normal fingertip.The average Maryland score of feet in the donor area was 87.66±7.39,which was satisfactory.Conclusion:Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen''s type IV fingertip amputations with a satisfactory appearance and good sensory function.