Reconstruction of Fingertip or Pulp Defects Using the Free Second Toe Tibial Flap With Plantar Vein
Bibliographic record
Abstract
PURPOSE: For patients with small-area emergency finger injuries and short venous defects, using the traditional second toe tibial free flap with dorsal toe veins would increase donor site damage and compromise the esthetic outcomes of both hands and feet. This study presents an innovative harvesting technique for the second toe tibial free flap, specifically designed for fingertip or volar pulp defect reconstruction. METHODS: From March 2020 to June 2023, our institution managed 15 cases of finger pulp or fingertip defects using second toe tibial flaps with plantar vein grafts, involving 16 digits. The cohort comprised 10 males and 5 females aged 20-60 years mean 38 years. All patients underwent immediate reconstruction with free second toe tibial flaps. Surgical procedures included: anastomosis of the plantar artery to the digital proper artery, plantar vein to palmar vein, and plantar nerve to digital proper nerve. RESULTS: Postoperative outcomes were assessed using two-point discrimination (2-PD), modified Vancouver Scar Scale (mVSS), Michigan Hand Outcome Questionnaire (MHOQ), and total active joint mobility (TAM). All 16 flaps survived without postoperative complications. The mean follow-up period was 11 months (range 6-18). Quantitative outcomes: Mean 2-PD: 9 mm (range 7-12). Donor site mVSS: 5 (range 4-7). Recipient site mVSS: 5 (range 4-7). MHOQ score: 8 (range 5-11). Thirteen patients reported complete satisfaction with reconstructed digit function and esthetics, while two expressed partial satisfaction. No prominent scarring was observed at foot donor sites. No secondary complications occurred during follow-up. CONCLUSIONS: The modified free second toe tibial flap technique demonstrates favorable clinical outcomes for digital pulp/tip reconstruction, achieving functional restoration with minimal donor site morbidity. This approach represents a valuable technique for widespread clinical adoption.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".