Microsurgical free toe pulp transfer for digital reconstruction.

Posttraumatic fingertip reconstruction with a free toe pulp neurovascular flap, first described in 1979, has not been frequently reported. We present our results with 8 free transfers of the toe pulp and demonstrate the successful restoration of a well-padded and sensitive fingertip. All patients, studied with a follow-up of up to 20 months, recovered a discriminative sensibility of the thumb and main fingers, with a stationary two-point discrimination test between 5 and 12 mm and a moving two-point discrimination test between 4 and 8 mm. In spite of the good results obtained, we believe this procedure must be chosen only in certain circumstances. We present the indications and the contraindications for this digital reconstruction.

[Plastic surgical reconstruction of cutaneous loss of the heel or sole of the foot with sensitive free flaps]. / A propos de la reconstruction plastique du talon et de la plante du pied par lambeaux libres sensibles.

In cases of total cutaneous loss of the heel or extensive cutaneous loss of the sole of the foot, the plastic surgical reconstruction by use of classical pediculated flaps requires following: - an adequate physical condition and articulations capable of enduring prolonged bed confinement in a position which is frequently uncomfortable; - a minimum of two operating procedures. It should be kept in mind that these free flaps are always insensitive and therefore subject to recurrence of wounding and trophic ulcers, etc. In order to avoid these drawbacks the authors suggest the use of a sensitive free flap, in which the neurovascular bundle is anastomosed to the existing bundle in the foot, using microsurgical techniques. Amongst the possible sensitive free flaps the authors favor the use of a sensitive latero-thoracic free flap. A detailed description of this free flap technique, its advantages and disadvantages for use in this kind of problem is described in their article. A clinical case is presented.