Outcomes of partial toe-pulp free flaps for fingertip reconstruction in patients 65 years and older: a retrospective case series

Purpose: This study investigated the outcomes and feasibility of partial toe-pulp free flap reconstruction for fingertip soft tissue defects in patients aged ≥65 years and aimed to address prevailing hesitations regarding microsurgical procedures in older adults with comorbidities.Methods: This retrospective case series included 21 patients aged ≥65 years who underwent partial toe-pulp free flap surgery at three institutions between 2020 and 2024. All patients had fingertip soft tissue defects and underwent microsurgical reconstruction due to joint immobility or a preference to avoid local flap procedures. Data collected included age, sex, comorbidities, smoking status, mechanism of injury, anesthesia type, flap size, survival, donor site morbidity, and patient satisfaction (3-point Likert scale).Results: The mean age was 67.0 years (range, 65–78 years), and all 21 flaps survived completely (100% survival). No donor-site morbidity was observed. The most common injury mechanism was crushing trauma (n=12), followed by incomplete (n=7) and complete amputations (n=2). Comorbidities included hypertension (n=10), diabetes mellitus (n=5), and cardiovascular disease (n=1); 14 patients were smokers. No statistically significant association was found between flap survival and comorbidities or smoking (all p>0.999). Patient satisfaction was reported as very satisfied in 13 cases (61.9%), somewhat satisfied in four (19.0%), and not satisfied in four (19.0%).Conclusion: Partial toe-pulp free flap reconstruction is a safe and effective option for older patients with fingertip soft tissue defects. Despite concerns regarding age and chronic disease, excellent outcomes and high satisfaction rates were achieved without major complications. With proper patient selection and technique, microsurgical fingertip reconstruction should not be avoided solely due to age or comorbidities.