Beyond finger reconstruction; where the esthetic refinements meet microsurgery.

BACKGROUND: Toe-to-hand transfer exemplifies the "like-with-like" principle and remains a reliable option for digit reconstruction. Here, we describe a modified technique to improve esthetic and functional outcomes in distal digit reconstruction. METHODS: From January 2021 to March 2024, 103 patients with 114 injured digits underwent reconstruction using a great toe wrap-around flap combined with iliac bone grafting. Indications included thumb injuries distal to the metacarpophalangeal (MCP) joint and other digit injuries distal to the proximal interphalangeal (PIP) joint. Donor sites were closed using full-thickness skin grafts. Outcomes were assessed based on sensory recovery, function, and esthetics. RESULTS: The cohort's mean age was 30.4 ± 15.5 yr and included 54% men. The thumb was the most commonly reconstructed digit (n = 43; 37.7%). Five patients (4.9%) required re-exploration for vascular compromise; one had partial flap loss. All other flaps survived. The mean iliac bone graft length was 17.7 ± 6.7 mm, with resorption in one case. Mean follow-up was 28.0 ± 11.7 months. At 6 months postoperatively, average static two-point discrimination was 8 mm (range: 7-10 mm), and the Semmes-Weinstein monofilament score averaged 2.83. All reconstructed digits achieved stable pinching and grasping. No significant donor-site complications, including no wound ulceration, delayed healing, persistent pain, cold intolerance, or gait disturbance, were observed. CONCLUSIONS: The modified great toe wrap-around flap with iliac bone grafting provides effective distal digit reconstruction with favorable functional and esthetic outcomes. It preserves toe integrity, minimizing donor-site morbidity while offering a viable option for microsurgical reconstruction.