title: Use of non-enhanced angiography to assist the second toetip flap transfer for reconstruction of the fingertip defect.
abstract: Toetip flap transfer is a useful reconstructive method for fingertip defect, but elevation of a toetip flap is technically demanding because of difficulty to dissect a pedicle vein of the flap. Recently, nonenhanced angiography (NEA) has been reported to be useful for preoperative visualization of the digital vessels without contrast enhancement or invasiveness. We report a case in which preoperative NEA visualized a vein suitable for a venous pedicle of a second toetip flap and facilitated successful toetip flap transfer for reconstruction of a fingertip defect. A 27-year-old male suffered from the right middle fingertip crush amputation in Tamai zone 1. The fingertip was reconstructed using a second toetip flap with preoperative NEA guidance. A pedicle vein was easily found and dissected exactly where NEA visualized. Nine months after the toetip flap transfer, the reconstructed right middle finger was functionally and aesthetically pleasing, and the toe nail at the donor site was preserved without any morbidity. NEA may help a surgeon to find drainage veins for a toetip flap, which leads to easier and more secure toetip flap transfer.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Megumi
authors.initials: M
authors.lastname: Taji
authors.forename: Gentaro
authors.initials: G
authors.lastname: Uchida
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000792:Angiography; D005383:Finger Injuries / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D014034:Toes / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D014680:Veins