14350 Filleted finger or toe flap, including preparation of recipient site

Name of the Procedure:

Filleted Finger or Toe Flap
Also known as: Fillet Flap, Pedicle Flap, Digital Fillet Flap

Summary

A filleted finger or toe flap procedure involves using the skin, tissue, and sometimes bone from an amputated or severely damaged finger or toe to reconstruct another area, typically on the hand or foot. This procedure provides a way to preserve functional and aesthetic properties by repurposing the patient's own tissue.

Purpose

The procedure addresses severe trauma or defects in the hand or foot, where conventional skin grafts or flaps are not sufficient. The primary goals are to restore function, improve appearance, and repair the defect with the patient’s own tissue to reduce the risk of rejection.

Indications

• Traumatic injury leading to severe finger or toe damage.
• Complex hand or foot defects requiring extensive soft tissue coverage.
• Inoperable tumors requiring segmental resection of a digit.
• Previous failed attempts with conventional reconstruction techniques.

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure if general anesthesia will be used.
• Preoperative assessments include physical examinations, imaging studies (e.g., X-rays, MRI), and blood tests.
• Medication adjustments may be necessary, especially if the patient takes blood thinners or has underlying medical conditions.

Procedure Description

1. Administer anesthesia: local, regional, or general, depending on the complexity and patient condition.
2. The surgeon meticulously creates incisions to harvest the skin, tissue, and possibly bone from the amputated or damaged finger or toe.
3. The harvested flap is then carefully shaped and transferred to the recipient site.
4. The recipient site is prepared by debriding (cleaning and removing dead tissue) and determining the exact placement for optimal function and aesthetics.
5. Microsurgical techniques are used to connect blood vessels and nerves, ensuring the viability of the transferred tissue.
6. The site is sutured and dressed appropriately.

Tools and equipment may include surgical scalpels, microvascular instruments, sutures, and possibly bone drills.

Duration

The procedure typically takes 3 to 6 hours, depending on the complexity and extent of reconstruction required.

Setting

Performed in a hospital operating room or specialized surgical center equipped with microsurgical facilities.

Personnel

• Plastic or orthopedic surgeon specialized in hand and foot reconstruction.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and technicians.
• Possible consultation with a microsurgeon.

Risks and Complications

• Infection at the donor or recipient site.
• Partial or complete loss of the flap due to inadequate blood supply.
• Scarring and possible deformities.
• Nerve damage leading to sensory or motor deficits.
• Prolonged recovery or rehabilitation.

Benefits

• Restoration of function and appearance to a damaged hand or foot.
• Use of patient's own tissue minimizes the risk of rejection.
• Improved quality of life by enabling better movement and dexterity.

Recovery

• Patients may need to stay in the hospital for 1-3 days for initial recovery and monitoring.
• Post-operative care includes wound care, pain management, and possibly antibiotics.
• Rehabilitation with physical and occupational therapy is often required.
• Full recovery can range from several weeks to months, with follow-up appointments necessary to monitor healing and progress.

Alternatives

• Skin grafts or synthetic skin substitutes.
• Prosthetics for missing or severely damaged digits.
• Other flap techniques such as rotational or free flaps.
• Each alternative has its pros and cons, such as varying levels of function and cosmetic outcomes, different recovery times, and varying risks of complications.

Patient Experience

During the procedure, patients under general anesthesia will be asleep and feel no pain. Post-operatively, patients may experience pain managed through medications. Discomfort, swelling, and limited use of the hand or foot are expected initially. Comfort measures include elevation, cold packs, and regular wound care. Physical therapy helps in gaining function and strength back over the recovery period.