Clinical Efficacy and Safety Evaluation of Total Microscopic Great Toenail Flap Transplantation for Finger Defect Reconstruction: A Retrospective Study of 38 Cases

Clinical Efficacy and Safety Evaluation of Total Microscopic Great Toenail Flap Transplantation for Finger Defect Reconstruction: A Retrospective Study of 38 Cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Efficacy and Safety Evaluation of Total Microscopic Great Toenail Flap Transplantation for Finger Defect Reconstruction: A Retrospective Study of 38 Cases Jiahao Li, Jiamin Wang, Jiguo Yang, Lingzhi Zheng, Zheng Huang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9030463/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Great toenail flap transplantation is an effective technique for repairing finger soft tissue defects. This study aimed to evaluate the clinical efficacy and safety of microscopically-assisted total great toenail flap transplantation for finger defect reconstruction. Methods: We retrospectively analyzed 38 patients with Allen type II, III, or IV finger injuries treated between January 2022 and January 2025. All surgical procedures were performed under total microscopic assistance. Assessed parameters included flap survival rates, complications (such as infection and vascular crisis), aesthetic appearance evaluated using the Vancouver Scar Scale (VSS), and functional recovery measured via the Michigan Hand Outcomes Questionnaire (MHQ) and static two-point discrimination (2-PD) test. Results: All transplanted flaps survived. The complication rate was low, with only three minor incidents that were resolved through appropriate intervention. Reconstructed fingers demonstrated satisfactory aesthetic outcomes (mean VSS score: 3.4) and excellent functional recovery (mean MHQ score: 88.4; mean 2-PD score: 8.0 mm). Patient satisfaction was high, with a mean visual analog scale (VAS) score of 84.1. Conclusion: Total microscopic great toenail flap transplantation is an effective and safe technique for finger defect reconstruction, yielding significant improvements in aesthetic appearance, functional recovery, and patient satisfaction. Trial registration: Clinical trial number: not applicable. Great toenail flap Finger defect Microsurgery Functional recovery Aesthetic outcome Patient satisfaction Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Fingers, as vital components of the hand, play a critical role in fine motor control and overall manual dexterity. The loss of one or more fingers can result in substantial functional impairment (particularly in grasping and pinching), as well as psychological distress and barriers to social participation. Notably, thumb amputation profoundly compromises hand function due to its central role in opposition and grip [ 1 ]. Furthermore, loss of other digits, such as the index and middle fingers, can disrupt coordinated hand movements and diminish the capacity to perform activities of daily living [ 2 ]. Current methods for repairing composite tissue defects of fingers, such as V-Y flaps and abdominal wall flaps, still have limitations in both functional and aesthetic reconstruction. With advancement in microsurgical techniques, toenail flaps transplantation has gained increasing attention. This is because the skin texture of the toenail flap closely resembles that of finger, offering substantial potential for sensory recovery [ 3 ]. This technique improves both sensory function and appearance of the fingers, thereby enhancing patient satisfaction [ 4 ]. The traditional method of harvesting nail bed flaps involves dissecting specific blood vessels and nerves under a microscope, followed by flap harvest under direct vision. However, poor visibility and the risk of surgical errors during this process may lead to damage to critical soft tissues. To address the aforementioned limitations, this study innovatively introduces the concept of harvesting and transplanting the great toenail flap entirely under microscopic visualization. This approach aims to minimize surgical trauma through meticulous intraoperative techniques, thereby enhancing the survival rate and functional recovery of the transplanted flap. Methods General Information This study retrospectively included 38 patients who underwent toenail flap transfer to finger defect reconstruction at Taizhou Enze Medical Group Enze Hospital from January 2022 to January 2025. Inclusion criteria were as follows: (1) patients with Allen type II, III, or IV injuries of the affected finger; (2) patients requiring reconstruction of hand function and appearance; (3) the donor toenail was normal in shape and without active infectious lesions; (4) patients who were physically capable for work and had no severe underlying diseases. All patients tolerated the surgery well. Exclusion criteria were as follows: (1) patients with other types of finger defects; (2) deformed or infected donor toenails; (3) patients with severe heart, liver, or kidney dysfunction, malignant tumors, or autoimmune or hematologic diseases who could not tolerate surgery; (4) poor compliance (defined as inability to return for follow-up for at least 6 months or failure to comply with medical advice). Surgical Techniques Thumb reconstruction is described below as a representative procedure. Debridement Debridement was performed to remove contaminants and necrotic tissue from the wound. The neurovascular bundles on both sides of the thumb were explored and tagged. Flap Design The length of the healthy contralateral thumb was measured, and a custom-shaped rubber sheath was fabricated using a sterile surgical glove, ensuring that its length matched that of the healthy thumb. The nail plate contour was outlined directly on the rubber sheath based on the dimensions of the healthy nail, and the corresponding defect area was marked. The rubber sheath was cut along the marked lines to create a defect template, which was then transferred to the ipsilateral great toe to guide the flap harvest area. Donor Site Harvesting All procedures were performed under microscopic visualization. An approximately 4- to 6-cm S-shaped incision was made along the dorsal side of the great toe to expose the venous network of the foot. The soft tissues were meticulously dissected using microsurgical scissors. Smaller veins were ligated with 9 − 0 sutures, while minute vessels were precisely coagulated with fine-tip electrocautery for hemostasis. Subsequently, two to three suitable dorsal veins were isolated as venous drainage pathways, followed by distal skin incision extension. The nail bed was then carefully elevated from the distal phalanx using a periosteal elevator. During plantar flap harvest, dissection was performed exclusively with microsurgical scissors to minimize electrocautery use and thereby reduce thermal injury to soft tissues. Concurrently, subcutaneous adipose tissue was appropriately thinned to prevent flap bulkiness and optimize functional and aesthetic outcomes. The lateral plantar artery was identified in the web space between the first and second toes, with its accompanying veins preserved whenever feasible to maintain perfusion. The tourniquet was then released to assess adequate vascular supply to the flap. Throughout the harvesting procedure, careful attention was paid to preserving vascular pedicles and nerves of sufficient length. For patients with bone defects, an iliac bone strip of appropriate length and width was harvested and fixed to the affected thumb using Kirschner wires. The flap was then transferred to the thumb defect site, and a mosaic suture technique was employed to reconstruct the finger contour. Under microscopic guidance, the plantar artery of the flap was first anastomosed to the ulnar digital artery of the recipient site, followed by anastomosis of the dorsal veins of the flap under appropriate tension. After tourniquet release, the reconstructed thumb showed favorable perfusion with prompt capillary refill. Finally, interrupted skin sutures were placed to complete the procedure. Skin defects at the foot donor site were managed either by direct closure or coverage with an artificial dermal matrix. Postoperative Management After surgery, patients were required to maintain strict bed rest for 7 to 10 days and received symptomatic treatment including warmth maintenance, analgesia, anticoagulation, and antispasmodic therapy. Flap color, skin temperature, turgor, and capillary refill were monitored hourly, and wound dressings were changed in a timely manner. Sutures were removed 12 to 14 days postoperatively, and rehabilitation exercises were initiated as early as 3 weeks after surgery. For patients who underwent iliac bone grafting, Kirschner wires were typically removed at 6 weeks postoperatively, based on radiographic evidence of bone healing. All patients underwent regular outpatient follow-up visits to assess both the flap and the donor site. Outcome Measures Patient satisfaction was evaluated using a Visual Analog Scale (VAS). Complications within 6 months postoperatively, including pain, infection, hypertrophic scarring, and fracture healing status, were recorded based on clinical and radiographic assessments. Sensation recovery of the flap was assessed using the static two-point discrimination (2PD) test [ 5 ]. At final follow-up, hand function, activities of daily living, work performance, aesthetic appearance, and patient satisfaction were evaluated using the Michigan Hand Outcomes Questionnaire (MHQ) [ 6 ]. The average score across the five domains (ranging from 0 to 100) was calculated, with higher scores indicating better hand function and appearance. Additionally, the aesthetic outcomes of both the reconstructed area and the donor site were assessed with the Vancouver Scar Scale (VSS) [ 7 ]. Results A total of 38 patients were enrolled, including 30 males and 8 females, with an age range of 18 to 56 years. The affected fingers comprised 15 thumbs, 18 index fingers, and 5 middle fingers. According to the Allen classification, there were 13 cases of type II, 19 of type III, and 6 of type IV injuries. One patient underwent staged reconstruction of the left thumb and left middle finger. Regarding the surgical approach, 16 patients underwent internal fixation with iliac bone grafting, while the remaining 22 patients did not receive bone grafting. All 38 flaps survived postoperatively. One patient developed a wound infection, which was resolved with dressing changes and antibiotic therapy. A female patient experienced a vascular crisis on the second postoperative day; this was successfully managed through surgical exploration and revision of the vascular anastomosis. One patient developed non-union at the iliac bone graft site, which required revision bone grafting and internal fixation with a plate, ultimately achieving union. Three patients were lost to follow-up before 3 months and were excluded from the final outcome analysis. The remaining 35 patients were followed for a period ranging from 6 to 25 months, with a mean follow-up of 14.8 months.(Table 1) Aesthetic Assessment of the Toenail Flaps: In the 35 evaluated cases, the reconstructed fingers showed comparable length, circumference, nail shape, color, and texture relative to the contralateral healthy fingers. The reconstructed fingertips exhibited appropriate volume and contour, resulting in an aesthetic shape based on symmetry and natural appearance. Four flaps were assessed as slightly bulky, while another four demonstrated hypertrophic scarring. Patient Satisfaction with Reconstructed Fingers: The mean visual analog scale (VAS) score for patient satisfaction was 84.1 (range: 60–92). Overall, these results indicate satisfactory aesthetic outcomes after reconstruction. At the final follow-up, 2-PD discrimination in the reconstructed fingers ranged from 6.0 to 11.0 mm, with a mean of 8.0 mm. The VSS score for the reconstructed site ranged from 2 to 5 points (mean: 3.4). For the donor site, the VSS score ranged from 3 to 7 points (mean: 4.6). The MHQ score ranged from 78 to 95 points (mean, 88.4).(Fig. 1 ) Donor-Site Morbidity :Direct closure of the toe donor site resulted in fine linear scars. Artificial dermal matrix coverage at the toe donor site required approximately 2 to 3 months for complete healing, with more noticeable hypertrophic scarring after healing. Both methods did not affect ambulatory function. Discussion Toenail flaps provide an effective approach for reconstructing finger defects, enabling optimal restoration of both form and function, particularly in cases involving nail bed loss [ 8 ]. The tissue characteristics of the flap closely resemble those of the finger, and the dense distribution of nerve endings within the nail-bearing region contributes to enhanced sensory recovery in the reconstructed digit [ 4 ]. All harvesting and transplantation procedures of the toenail flaps were performed under continuous microscopic assistance. We conducted a retrospective analysis to systematically evaluate the clinical efficacy and safety of this approach, assessing postoperative flap survival, functional recovery, and aesthetic satisfaction using standardized patient-reported outcome measures. The study demonstrated that all transplanted flaps survived and achieved favorable aesthetic outcomes. Functionally and sensorily, the reconstructed digits exhibited excellent clinical results with high patient satisfaction. Donor-toe function was not significantly compromised postoperatively. However, aesthetic outcomes at the donor site were moderately reduced due to more noticeable hypertrophic scarring compared with the reconstructed finger, which was attributable to the use of a skin substitute. Preservation of the toe phalanx had minimal impact on overall foot function. The toenail flap promotes the recovery of sensory function postoperatively due to its anatomical structure, which closely resembles finger skin, and its rich distribution of sensory nerves, consistent with previous studies describing its advantages [ 8 , 9 ]. Traditional toenail flap harvest involves dissecting the main blood vessels and nerves using a microscope, while other parts of the flap are harvested under direct vision. This method often results in limited visibility, difficulty in tissue dissection, and increased risk of injury. In contrast, the entire flap harvest and transfer in this study were performed using microscopic techniques. This approach enabled precise dissection and clear identification of the course and delicate branches of the vessels, thereby ensuring the integrity and sufficient length of the vascular pedicle from its source. This approach not only avoids excessive soft tissue damage but also significantly reduces the incidence of vascular complications caused by traction injuries and tears. By minimizing these complications, this approach ensures flap survival and functional reconstruction. During the procedure, meticulous ligation of vascular branches was performed to minimize postoperative wound bleeding and reduce the risk of venous congestion caused by subcutaneous hematoma, while ensuring perfusion through the main vascular pedicle. The use of electrocautery was minimized during flap harvesting to avoid thermal injury to soft tissues. Compared with conventional operations, the use of the microscope throughout the operation may extend the operation time by 1 to 1.5 hours. However, this approach can significantly reduce damage caused during surgical manipulation. In addition, the use of a microscope throughout the surgical process is also applicable for the collection of other small skin flaps, such as the superficial branch of the radial artery flap. However, the transplantation of larger flaps using this technique is not recommended, as the prolonged operative time increases the risk of anesthesia. In this study, a sterile rubber glove was used as a modeling template to simplify the design process. By cutting the glove, the three-dimensional defect was converted into a two-dimensional pattern. This approach facilitated accurate transfer of the defect dimensions to the donor toe site, thereby avoiding issues related to oversized or undersized flap harvest. Bulky appearance of the reconstructed finger remains a common postoperative concern [ 10 ]. In this study, complete microscopic harvesting and thinning of the flap enabled visually guided preservation of the subcutaneous vascular network. Under magnified view, surgeons could precisely excise redundant adipose tissue from the lateral and dorsal aspects of the toe. This meticulous approach allowed the transplanted flap to closely approximate the contour and nail morphology of a normal thumb, effectively obviating the need for secondary debulking procedures and significantly improving both aesthetic outcomes and patient satisfaction. The favorable 2-PD discrimination and MHQ scores observed following toenail flap transplantation indicate effective sensory nerve regeneration and functional restoration. The dense distribution of nerve endings within the toenail flap provides a conducive microenvironment for neural regeneration, facilitating neurotization with recipient nerve stumps and thereby enhancing sensory recovery[ 8 ]. Compared with other local flap techniques, the toenail flap demonstrates superior restoration of fingertip fine sensation, attributable in part to its unique neural architecture and shorter regenerative distance[ 11 ]. Furthermore, the similar skin thickness and elasticity between the flap and native finger skin aid in restoring mechanical transduction, thereby supporting functional rehabilitation [ 12 ]. These combined mechanisms explain the high functional scores in the present cohort and provide a biological rationale for the functional advantages of toenail flap transplantation in digital reconstruction. The low incidence of postoperative complications in this study, particularly regarding vascular compromise and infection, can be largely attributed to meticulous microscopic technique and comprehensive perioperative management [ 13 ]. Microsurgical precision in vascular and neural coaptation minimizes anastomotic tension and hemodynamic disturbances, reducing the risk of vasospasm and thrombosis [ 14 ]. Moreover, careful handling of vessels and adjacent tissues during surgery mitigates local inflammatory responses and edema, further contributing to infection prevention [ 15 ]. While the fully microscope-assisted procedure demands greater microsurgical skill and sustained focus from the surgeon, and may extend operative time to a certain extent, its advantages in enhancing procedural safety and optimizing postoperative appearance and function are significant. This study represents a preliminary investigation limited by sample size; therefore, the long-term efficacy and broader applicability of this technique require further validation through larger-scale, multicenter randomized controlled trials. Conclusion This study establishes that total microscopic assistance throughout toenail flap transplantation offers a refined approach for finger reconstruction. Compared with conventional surgical procedures, this study provides new evidence that microscopic precision enables safe, single-stage contouring and reduces vascular complications, thereby confirming that the prolonged operative time yields superior functional and aesthetic outcomes. The adoption of full microscopic assistance in small-flap transplantation reflects a trend toward refinement and precision in surgical practice. This method represents an advance in meticulous digital reconstruction. Abbreviations Visual Analog Scale VAS Vancouver Scar Scale VSS two-point discrimination 2P-D Michigan Hand Outcomes Questionnaire MHQ Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of [The Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical (K20251011)], and informed consent was obtained from all participants involved in the study Consent for publication The manuscript is approved for publication by all the authors. Written informed consent was obtained from the patients and/or their legal guardiansfor publication, and any accompanying images, sex, age of these patients. Availability of data and materials Data is provided within the manuscript or supplementary information files. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships. Funding No funding was received for conducting this study or for the preparation of this manuscript. Authors' contributions Jiahao Li (First authors) and Jiamin Wang (Co-first authors): Study conceptualization, design, and original draft writing.Shilin Gu (Corresponding author)and Mengyuan Chen: Manuscript review, editing, and polishing.Jiguo Yang and Lingzhi Zheng: Patient follow-up, data collection, and formal analysis.Zhen Huang: Data visualization and figure preparation.All authors approved the final manuscript. Acknowledgements Not applicable References Heitmann C, Levin LS. Alternatives to thumb replantation. Plast Reconstr Surg. 2002;110(6):1492-1503. doi:10.1097/01.PRS.0000029362.01985.80. Belić JJ, Faisal AA. Decoding of human hand actions to handle missing limbs in neuroprosthetics. Front Comput Neurosci. 2015;9:27. doi:10.3389/fncom.2015.00027. Ju JH, Hou RX. Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report. Arch Orthop Trauma Surg. 2013;133(10):1455-1458. doi:10.1007/s00402-013-1807-5. Cai L, Zhang X, Zhang Y, et al. Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer. Orthop Surg. 2023;15(10):2716-2723. doi:10.1111/os.13829. Bao QY, Xiao CW, Peng F, Han D, Wang T, Gu YD. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg. 2014;30(1):15-20. doi:10.1055/s-0033-1345430. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575-587. doi:10.1016/S0363-5023(98)80042-7. Cai L, Zhang X, Zhang Y, Xiang G, Luo P, Li Z, et al. Reconstruction of composite soft tissue defect in the distal finger using partial toenail flap transfer. Orthop Surg. 2023;15(10):2716-2723. doi:10.1111/os.13829. Zhao W, Yin G, Liu L, Zhao J. Staged hand-foot flap reciprocity: A microsurgical protocol utilizing great toenail flap for finger defect reconstruction. Injury. 2025;56(11):112745. doi:10.1016/j.injury.2025.112745. Ju JH, Hou RX. Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report. Arch Orthop Trauma Surg. 2013;133(10):1455-1458. doi:10.1007/s00402-013-1807-5. Zhang J, Xie Z, Lei Y, Song J, Guo Q, Xiao J. Free second toe one-stage-plasty and transfer for thumb or finger reconstruction. Microsurgery. 2008;28(1):25-31. doi:10.1002/micr.20447. Fan X, Zhou Y, Zhou J, Dai S, Liu J, Lao K. The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory. BMC Surg. 2023;23(1):231. doi:10.1186/s12893-023-02097-1. Vergara-Amador E, Quintero-Lozano JA, Linero-Lozano GA. Innervated digital artery perforator flap: a reliable and versatile technique for fingertip reconstruction. J Hand Surg Eur Vol. 2012;37(3):271-272. doi:10.1177/1753193411422685. Zhang H, Zhang F, Zhang H, et al. Analysis of risk factors for vascular crisis in thumb reconstruction with free toe flap. Microsurgery. 2019;39(8):732-737. doi:10.1002/micr.30495. Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128(3):723-737. doi:10.1097/PRS.0b013e31822b6747. Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010;32(9):1236-1245. doi:10.1002/hed.21284. Table Table 1 Demographic and clinical characteristics of 38 patients No. Sex Age （ y ） Allen type Diagnosis Duration of surgery （min） Complication follow-up （M） VAS MHQ VSS ( Reconstructed site) VSS (Donor site ) 2-PD（mm） 1 F 45 III Right index finger 480 scar 10 90 86 5 5 6 2 M 41 III left thumb 595 8 95 85 3 4 8.1 3 M 26 III left thumb 480 12 70 88 3 5 8.8 4 F 43 IV Right index finger 640 Infection and non healing of bones 12 85 82 3 4 6.2 5 M 26 IV left middle finger 580 bulky 6 88 88 2 3 9.9 6 M 34 II Right index finger 420 10 75 90 3 3 8.8 7 M 32 II left index finger 360 13 90 86 2 4 9.8 8 F 26 II left thumb 280 12 79 92 4 6 8.2 9 F 26 III left thumb 400 scar 14 88 87 5 5 9.1 10 M 44 III left index finger 485 18 75 95 3 4 8.2 11 M 52 IV Right thumb 590 14 95 88 3 4 9.1 12 M 40 II left index finger 350 18 75 88 3 5 7.3 13 M 43 II left thumb 405 14 90 90 3 4 7.2 14 M 47 III left index finger 420 bulky 12 85 92 5 5 7.5 15 M 42 III Right index finger 485 18 88 89 3 6 8.1 16 M 18 II Right index finger 325 15 90 90 2 4 6.3 17 M 20 II Left middle finger 300 21 78 88 3 5 7.3 18 M 25 III left thumb 485 22 92 94 3 4 6.8 19 M 31 IV Right index finger 540 20 80 90 3 4 6.6 20 M 56 III left thumb 480 bulky 19 90 90 3 5 11 21 M 35 III left index finger 455 scar 18 85 92 5 5 8.5 22 M 33 II Right thumb 480 15 90 87 3 6 7.3 23 F 45 II Right middle finger 420 12 85 86 3 7 8.9 24 M 18 III Right index finger 490 6 80 88 3 4 7 25 F 31 II left index finger 360 15 90 90 3 5 8 26 M 25 II Right index finger 300 25 85 92 2 5 9 27 M 52 III left index finger 600 9 88 84 3 5 8.5 28 M 26 IV left middle finger 490 12 75 90 3 4 7.7 29 M 28 III Right thumb 520 bulky 19 90 88 5 5 7.8 30 M 49 IV left thumb 480 9 80 90 4 4 8.2 31 F 30 II left index finger 425 12 90 83 3 5 6.9 32 M 39 III Right thumb 560 scarring 17 60 78 5 4 7 33 M 44 III left index finger 600 16 80 93 4 5 8 34 M 53 III left thumb 475 22 85 85 4 4 9.5 35 M 21 III Right index finger 535 25 85 90 4 3 9 Additional Declarations No competing interests reported. Supplementary Files Data.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9030463","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623864480,"identity":"e57ea066-9839-476e-a2f1-ad8b6ca80bb9","order_by":0,"name":"Jiahao Li","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiahao","middleName":"","lastName":"Li","suffix":""},{"id":623864481,"identity":"d0b44d0e-8e75-460c-be9a-844b114dbb7a","order_by":1,"name":"Jiamin Wang","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiamin","middleName":"","lastName":"Wang","suffix":""},{"id":623864482,"identity":"481b011a-3955-46cd-9a9e-9be827919819","order_by":2,"name":"Jiguo Yang","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiguo","middleName":"","lastName":"Yang","suffix":""},{"id":623864483,"identity":"b1b2c2be-d1c5-4a78-920a-f86bda7b16f7","order_by":3,"name":"Lingzhi Zheng","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lingzhi","middleName":"","lastName":"Zheng","suffix":""},{"id":623864484,"identity":"397e9be1-0c09-4c17-98f4-ee9221bbad1d","order_by":4,"name":"Zheng Huang","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"Huang","suffix":""},{"id":623864486,"identity":"32c7b156-0373-4c33-9125-428c290bbfbf","order_by":5,"name":"Shilin Gu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBAC+4bzHw58qJCQY2NvIFKLAeMBw4MzzlgY8/EcIFYL8wHjw7xtFYlyEglEajFnO5BwcGabRAKb5OONNxhqbKIJarHsOXDgwIdzEnls0mnFFgzH0nIbCOq5cbDh4IwyiWI26RwzCcaGw0Rouf+Y4TAPm0Rim+QZIrUYHDgG1NIG1CLBQ6QWyYYzDMBAljBm4wH6JYEYv/AznGH+8KGiTk6+/fDGGx9qbIjwC7IjiY4aJC2k6hgFo2AUjIKRAQAg80SoUE94lQAAAABJRU5ErkJggg==","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shilin","middleName":"","lastName":"Gu","suffix":""},{"id":623864487,"identity":"30720510-ed72-4ac3-b5e4-50b1fa4529c7","order_by":6,"name":"Mengyuan Chen","email":"","orcid":"","institution":"Taizhou Hospital,Zhejiang University Proince affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mengyuan","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2026-03-04 12:54:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9030463/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9030463/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107244642,"identity":"54a2459f-310e-4f04-87db-11cc0c02ca55","added_by":"auto","created_at":"2026-04-19 07:55:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67696,"visible":true,"origin":"","legend":"\u003cp\u003eBox Plots of Patient VAS, MHQ, 2-PD Scores and Donor/Recipient Site VSS Scores\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/91bf2dcd683f84b9f092fafc.png"},{"id":107244605,"identity":"2dfebb9a-44a5-4db2-99ea-21a12880382d","added_by":"auto","created_at":"2026-04-19 07:55:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1386412,"visible":true,"origin":"","legend":"\u003cp\u003eA photo of (a) A 26-year-old male patient presented with soft tissue defects in the right thumb and middle finger, along with destruction of the index finger, resulting from machine crush injury.（b, c）The initial procedure involved reconstruction of the left thumb using a wrap-around great toenail flap,with all procedures performed under microscopic guidance.（d,e）A rubber glove was utilized as a template for designing the flap.（f）The donor site on the left great toe was covered with an artificial dermis.（g）The remaining soft tissue defect was temporarily covered with bone cement, with definitive wound repair planned for the second stage.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/0e6e7e923ec93ad4b474c006.png"},{"id":107244682,"identity":"fb0511f9-bd6d-4c14-9c35-02abe4962495","added_by":"auto","created_at":"2026-04-19 07:55:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1015896,"visible":true,"origin":"","legend":"\u003cp\u003eA photo of (a)One and a half months postoperatively, reconstruction of the left middle finger was performed using a second wrap-around great toenail flap.(b, c)A rubber glove was utilized as a template for designing the flap.（d）The second metacarpal head was excised to create the first web space, followed by reconstruction of the middle finger using a great toenail flap.（e）The donor site was covered with artificial dermis.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/96c291df7207ab1be456c461.png"},{"id":107244685,"identity":"17111bbb-4fe8-4427-9905-a1c0f560365e","added_by":"auto","created_at":"2026-04-19 07:55:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":877587,"visible":true,"origin":"","legend":"\u003cp\u003eAt one-year follow-up, both flaps exhibited favorable appearance and function. The donor sites on both feet healed with scar formation, without impairment of walking ability(a,b,c,d).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/d44e2e64145a52530f138068.png"},{"id":108977198,"identity":"34cb2a55-e4c0-41a3-b4fa-88d483dfa75f","added_by":"auto","created_at":"2026-05-11 11:30:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5269775,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/18ccd831-0692-4ea0-8ae6-c3e8adb0b688.pdf"},{"id":107244681,"identity":"a165ca99-368f-4876-99ed-e668cc5774be","added_by":"auto","created_at":"2026-04-19 07:55:25","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16729,"visible":true,"origin":"","legend":"","description":"","filename":"Data.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9030463/v1/2f87dd223850eb2c08975548.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Efficacy and Safety Evaluation of Total Microscopic Great Toenail Flap Transplantation for Finger Defect Reconstruction: A Retrospective Study of 38 Cases","fulltext":[{"header":"Background","content":"\u003cp\u003eFingers, as vital components of the hand, play a critical role in fine motor control and overall manual dexterity. The loss of one or more fingers can result in substantial functional impairment (particularly in grasping and pinching), as well as psychological distress and barriers to social participation. Notably, thumb amputation profoundly compromises hand function due to its central role in opposition and grip [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Furthermore, loss of other digits, such as the index and middle fingers, can disrupt coordinated hand movements and diminish the capacity to perform activities of daily living [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrent methods for repairing composite tissue defects of fingers, such as V-Y flaps and abdominal wall flaps, still have limitations in both functional and aesthetic reconstruction. With advancement in microsurgical techniques, toenail flaps transplantation has gained increasing attention. This is because the skin texture of the toenail flap closely resembles that of finger, offering substantial potential for sensory recovery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This technique improves both sensory function and appearance of the fingers, thereby enhancing patient satisfaction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The traditional method of harvesting nail bed flaps involves dissecting specific blood vessels and nerves under a microscope, followed by flap harvest under direct vision. However, poor visibility and the risk of surgical errors during this process may lead to damage to critical soft tissues. To address the aforementioned limitations, this study innovatively introduces the concept of harvesting and transplanting the great toenail flap entirely under microscopic visualization. This approach aims to minimize surgical trauma through meticulous intraoperative techniques, thereby enhancing the survival rate and functional recovery of the transplanted flap.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eGeneral Information\u003c/p\u003e \u003cp\u003eThis study retrospectively included 38 patients who underwent toenail flap transfer to finger defect reconstruction at Taizhou Enze Medical Group Enze Hospital from January 2022 to January 2025. Inclusion criteria were as follows: (1) patients with Allen type II, III, or IV injuries of the affected finger; (2) patients requiring reconstruction of hand function and appearance; (3) the donor toenail was normal in shape and without active infectious lesions; (4) patients who were physically capable for work and had no severe underlying diseases. All patients tolerated the surgery well. Exclusion criteria were as follows: (1) patients with other types of finger defects; (2) deformed or infected donor toenails; (3) patients with severe heart, liver, or kidney dysfunction, malignant tumors, or autoimmune or hematologic diseases who could not tolerate surgery; (4) poor compliance (defined as inability to return for follow-up for at least 6 months or failure to comply with medical advice).\u003c/p\u003e \u003cp\u003eSurgical Techniques\u003c/p\u003e \u003cp\u003eThumb reconstruction is described below as a representative procedure.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDebridement\u003c/h2\u003e \u003cp\u003eDebridement was performed to remove contaminants and necrotic tissue from the wound. The neurovascular bundles on both sides of the thumb were explored and tagged.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFlap Design\u003c/h3\u003e\n\u003cp\u003eThe length of the healthy contralateral thumb was measured, and a custom-shaped rubber sheath was fabricated using a sterile surgical glove, ensuring that its length matched that of the healthy thumb. The nail plate contour was outlined directly on the rubber sheath based on the dimensions of the healthy nail, and the corresponding defect area was marked. The rubber sheath was cut along the marked lines to create a defect template, which was then transferred to the ipsilateral great toe to guide the flap harvest area.\u003c/p\u003e\n\u003ch3\u003eDonor Site Harvesting\u003c/h3\u003e\n\u003cp\u003eAll procedures were performed under microscopic visualization. An approximately 4- to 6-cm S-shaped incision was made along the dorsal side of the great toe to expose the venous network of the foot. The soft tissues were meticulously dissected using microsurgical scissors. Smaller veins were ligated with 9\u0026thinsp;\u0026minus;\u0026thinsp;0 sutures, while minute vessels were precisely coagulated with fine-tip electrocautery for hemostasis. Subsequently, two to three suitable dorsal veins were isolated as venous drainage pathways, followed by distal skin incision extension. The nail bed was then carefully elevated from the distal phalanx using a periosteal elevator. During plantar flap harvest, dissection was performed exclusively with microsurgical scissors to minimize electrocautery use and thereby reduce thermal injury to soft tissues. Concurrently, subcutaneous adipose tissue was appropriately thinned to prevent flap bulkiness and optimize functional and aesthetic outcomes. The lateral plantar artery was identified in the web space between the first and second toes, with its accompanying veins preserved whenever feasible to maintain perfusion. The tourniquet was then released to assess adequate vascular supply to the flap. Throughout the harvesting procedure, careful attention was paid to preserving vascular pedicles and nerves of sufficient length.\u003c/p\u003e \u003cp\u003eFor patients with bone defects, an iliac bone strip of appropriate length and width was harvested and fixed to the affected thumb using Kirschner wires. The flap was then transferred to the thumb defect site, and a mosaic suture technique was employed to reconstruct the finger contour. Under microscopic guidance, the plantar artery of the flap was first anastomosed to the ulnar digital artery of the recipient site, followed by anastomosis of the dorsal veins of the flap under appropriate tension. After tourniquet release, the reconstructed thumb showed favorable perfusion with prompt capillary refill. Finally, interrupted skin sutures were placed to complete the procedure. Skin defects at the foot donor site were managed either by direct closure or coverage with an artificial dermal matrix.\u003c/p\u003e \u003cp\u003ePostoperative Management\u003c/p\u003e \u003cp\u003eAfter surgery, patients were required to maintain strict bed rest for 7 to 10 days and received symptomatic treatment including warmth maintenance, analgesia, anticoagulation, and antispasmodic therapy. Flap color, skin temperature, turgor, and capillary refill were monitored hourly, and wound dressings were changed in a timely manner. Sutures were removed 12 to 14 days postoperatively, and rehabilitation exercises were initiated as early as 3 weeks after surgery. For patients who underwent iliac bone grafting, Kirschner wires were typically removed at 6 weeks postoperatively, based on radiographic evidence of bone healing. All patients underwent regular outpatient follow-up visits to assess both the flap and the donor site.\u003c/p\u003e \u003cp\u003eOutcome Measures\u003c/p\u003e \u003cp\u003ePatient satisfaction was evaluated using a Visual Analog Scale (VAS). Complications within 6 months postoperatively, including pain, infection, hypertrophic scarring, and fracture healing status, were recorded based on clinical and radiographic assessments. Sensation recovery of the flap was assessed using the static two-point discrimination (2PD) test [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. At final follow-up, hand function, activities of daily living, work performance, aesthetic appearance, and patient satisfaction were evaluated using the Michigan Hand Outcomes Questionnaire (MHQ) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The average score across the five domains (ranging from 0 to 100) was calculated, with higher scores indicating better hand function and appearance. Additionally, the aesthetic outcomes of both the reconstructed area and the donor site were assessed with the Vancouver Scar Scale (VSS) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 38 patients were enrolled, including 30 males and 8 females, with an age range of 18 to 56 years. The affected fingers comprised 15 thumbs, 18 index fingers, and 5 middle fingers. According to the Allen classification, there were 13 cases of type II, 19 of type III, and 6 of type IV injuries. One patient underwent staged reconstruction of the left thumb and left middle finger. Regarding the surgical approach, 16 patients underwent internal fixation with iliac bone grafting, while the remaining 22 patients did not receive bone grafting. All 38 flaps survived postoperatively. One patient developed a wound infection, which was resolved with dressing changes and antibiotic therapy. A female patient experienced a vascular crisis on the second postoperative day; this was successfully managed through surgical exploration and revision of the vascular anastomosis. One patient developed non-union at the iliac bone graft site, which required revision bone grafting and internal fixation with a plate, ultimately achieving union. Three patients were lost to follow-up before 3 months and were excluded from the final outcome analysis. The remaining 35 patients were followed for a period ranging from 6 to 25 months, with a mean follow-up of 14.8 months.(Table\u0026nbsp;1)\u003c/p\u003e \u003cp\u003eAesthetic Assessment of the Toenail Flaps: In the 35 evaluated cases, the reconstructed fingers showed comparable length, circumference, nail shape, color, and texture relative to the contralateral healthy fingers. The reconstructed fingertips exhibited appropriate volume and contour, resulting in an aesthetic shape based on symmetry and natural appearance. Four flaps were assessed as slightly bulky, while another four demonstrated hypertrophic scarring. Patient Satisfaction with Reconstructed Fingers: The mean visual analog scale (VAS) score for patient satisfaction was 84.1 (range: 60\u0026ndash;92). Overall, these results indicate satisfactory aesthetic outcomes after reconstruction. At the final follow-up, 2-PD discrimination in the reconstructed fingers ranged from 6.0 to 11.0 mm, with a mean of 8.0 mm. The VSS score for the reconstructed site ranged from 2 to 5 points (mean: 3.4). For the donor site, the VSS score ranged from 3 to 7 points (mean: 4.6). The MHQ score ranged from 78 to 95 points (mean, 88.4).(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDonor-Site Morbidity :Direct closure of the toe donor site resulted in fine linear scars. Artificial dermal matrix coverage at the toe donor site required approximately 2 to 3 months for complete healing, with more noticeable hypertrophic scarring after healing. Both methods did not affect ambulatory function.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eToenail flaps provide an effective approach for reconstructing finger defects, enabling optimal restoration of both form and function, particularly in cases involving nail bed loss [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The tissue characteristics of the flap closely resemble those of the finger, and the dense distribution of nerve endings within the nail-bearing region contributes to enhanced sensory recovery in the reconstructed digit [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. All harvesting and transplantation procedures of the toenail flaps were performed under continuous microscopic assistance. We conducted a retrospective analysis to systematically evaluate the clinical efficacy and safety of this approach, assessing postoperative flap survival, functional recovery, and aesthetic satisfaction using standardized patient-reported outcome measures.\u003c/p\u003e \u003cp\u003eThe study demonstrated that all transplanted flaps survived and achieved favorable aesthetic outcomes. Functionally and sensorily, the reconstructed digits exhibited excellent clinical results with high patient satisfaction. Donor-toe function was not significantly compromised postoperatively. However, aesthetic outcomes at the donor site were moderately reduced due to more noticeable hypertrophic scarring compared with the reconstructed finger, which was attributable to the use of a skin substitute. Preservation of the toe phalanx had minimal impact on overall foot function.\u003c/p\u003e \u003cp\u003eThe toenail flap promotes the recovery of sensory function postoperatively due to its anatomical structure, which closely resembles finger skin, and its rich distribution of sensory nerves, consistent with previous studies describing its advantages [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Traditional toenail flap harvest involves dissecting the main blood vessels and nerves using a microscope, while other parts of the flap are harvested under direct vision. This method often results in limited visibility, difficulty in tissue dissection, and increased risk of injury. In contrast, the entire flap harvest and transfer in this study were performed using microscopic techniques. This approach enabled precise dissection and clear identification of the course and delicate branches of the vessels, thereby ensuring the integrity and sufficient length of the vascular pedicle from its source. This approach not only avoids excessive soft tissue damage but also significantly reduces the incidence of vascular complications caused by traction injuries and tears. By minimizing these complications, this approach ensures flap survival and functional reconstruction.\u003c/p\u003e \u003cp\u003eDuring the procedure, meticulous ligation of vascular branches was performed to minimize postoperative wound bleeding and reduce the risk of venous congestion caused by subcutaneous hematoma, while ensuring perfusion through the main vascular pedicle. The use of electrocautery was minimized during flap harvesting to avoid thermal injury to soft tissues. Compared with conventional operations, the use of the microscope throughout the operation may extend the operation time by 1 to 1.5 hours. However, this approach can significantly reduce damage caused during surgical manipulation. In addition, the use of a microscope throughout the surgical process is also applicable for the collection of other small skin flaps, such as the superficial branch of the radial artery flap. However, the transplantation of larger flaps using this technique is not recommended, as the prolonged operative time increases the risk of anesthesia.\u003c/p\u003e \u003cp\u003eIn this study, a sterile rubber glove was used as a modeling template to simplify the design process. By cutting the glove, the three-dimensional defect was converted into a two-dimensional pattern. This approach facilitated accurate transfer of the defect dimensions to the donor toe site, thereby avoiding issues related to oversized or undersized flap harvest.\u003c/p\u003e \u003cp\u003eBulky appearance of the reconstructed finger remains a common postoperative concern [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this study, complete microscopic harvesting and thinning of the flap enabled visually guided preservation of the subcutaneous vascular network. Under magnified view, surgeons could precisely excise redundant adipose tissue from the lateral and dorsal aspects of the toe. This meticulous approach allowed the transplanted flap to closely approximate the contour and nail morphology of a normal thumb, effectively obviating the need for secondary debulking procedures and significantly improving both aesthetic outcomes and patient satisfaction.\u003c/p\u003e \u003cp\u003eThe favorable 2-PD discrimination and MHQ scores observed following toenail flap transplantation indicate effective sensory nerve regeneration and functional restoration. The dense distribution of nerve endings within the toenail flap provides a conducive microenvironment for neural regeneration, facilitating neurotization with recipient nerve stumps and thereby enhancing sensory recovery[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Compared with other local flap techniques, the toenail flap demonstrates superior restoration of fingertip fine sensation, attributable in part to its unique neural architecture and shorter regenerative distance[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, the similar skin thickness and elasticity between the flap and native finger skin aid in restoring mechanical transduction, thereby supporting functional rehabilitation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These combined mechanisms explain the high functional scores in the present cohort and provide a biological rationale for the functional advantages of toenail flap transplantation in digital reconstruction. The low incidence of postoperative complications in this study, particularly regarding vascular compromise and infection, can be largely attributed to meticulous microscopic technique and comprehensive perioperative management [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Microsurgical precision in vascular and neural coaptation minimizes anastomotic tension and hemodynamic disturbances, reducing the risk of vasospasm and thrombosis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, careful handling of vessels and adjacent tissues during surgery mitigates local inflammatory responses and edema, further contributing to infection prevention [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile the fully microscope-assisted procedure demands greater microsurgical skill and sustained focus from the surgeon, and may extend operative time to a certain extent, its advantages in enhancing procedural safety and optimizing postoperative appearance and function are significant. This study represents a preliminary investigation limited by sample size; therefore, the long-term efficacy and broader applicability of this technique require further validation through larger-scale, multicenter randomized controlled trials.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study establishes that total microscopic assistance throughout toenail flap transplantation offers a refined approach for finger reconstruction. Compared with conventional surgical procedures, this study provides new evidence that microscopic precision enables safe, single-stage contouring and reduces vascular complications, thereby confirming that the prolonged operative time yields superior functional and aesthetic outcomes. The adoption of full microscopic assistance in small-flap transplantation reflects a trend toward refinement and precision in surgical practice. This method represents an advance in meticulous digital reconstruction.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVisual Analog Scale\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVancouver Scar Scale\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVSS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003etwo-point discrimination\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e2P-D\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMichigan Hand Outcomes Questionnaire\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMHQ\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of [The Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical (K20251011)], and informed consent was obtained from all participants involved in the study\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eThe manuscript is approved for publication by all the authors. Written informed consent was obtained from the patients and/or their legal guardiansfor publication, and any accompanying images, sex, age of these patients.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study or for the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eJiahao Li (First authors) and Jiamin Wang (Co-first authors): Study conceptualization, design, and original draft writing.Shilin Gu (Corresponding author)and Mengyuan Chen: Manuscript review, editing, and polishing.Jiguo Yang and Lingzhi Zheng: Patient follow-up, data collection, and formal analysis.Zhen Huang: Data visualization and figure preparation.All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHeitmann C, Levin LS. Alternatives to thumb replantation. Plast Reconstr Surg. 2002;110(6):1492-1503. doi:10.1097/01.PRS.0000029362.01985.80.\u003c/li\u003e\n \u003cli\u003eBelić JJ, Faisal AA. Decoding of human hand actions to handle missing limbs in neuroprosthetics. Front Comput Neurosci. 2015;9:27. doi:10.3389/fncom.2015.00027.\u003c/li\u003e\n \u003cli\u003eJu JH, Hou RX. Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report. Arch Orthop Trauma Surg. 2013;133(10):1455-1458. doi:10.1007/s00402-013-1807-5.\u003c/li\u003e\n \u003cli\u003eCai L, Zhang X, Zhang Y, et al. Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer. Orthop Surg. 2023;15(10):2716-2723. doi:10.1111/os.13829.\u003c/li\u003e\n \u003cli\u003eBao QY, Xiao CW, Peng F, Han D, Wang T, Gu YD. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg. 2014;30(1):15-20. doi:10.1055/s-0033-1345430.\u003c/li\u003e\n \u003cli\u003eChung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575-587. doi:10.1016/S0363-5023(98)80042-7.\u003c/li\u003e\n \u003cli\u003eCai L, Zhang X, Zhang Y, Xiang G, Luo P, Li Z, et al. Reconstruction of composite soft tissue defect in the distal finger using partial toenail flap transfer. Orthop Surg. 2023;15(10):2716-2723. doi:10.1111/os.13829.\u003c/li\u003e\n \u003cli\u003eZhao W, Yin G, Liu L, Zhao J. Staged hand-foot flap reciprocity: A microsurgical protocol utilizing great toenail flap for finger defect reconstruction. Injury. 2025;56(11):112745. doi:10.1016/j.injury.2025.112745.\u003c/li\u003e\n \u003cli\u003eJu JH, Hou RX. Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report. Arch Orthop Trauma Surg. 2013;133(10):1455-1458. doi:10.1007/s00402-013-1807-5.\u003c/li\u003e\n \u003cli\u003eZhang J, Xie Z, Lei Y, Song J, Guo Q, Xiao J. Free second toe one-stage-plasty and transfer for thumb or finger reconstruction. Microsurgery. 2008;28(1):25-31. doi:10.1002/micr.20447.\u003c/li\u003e\n \u003cli\u003eFan X, Zhou Y, Zhou J, Dai S, Liu J, Lao K. The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory. BMC Surg. 2023;23(1):231. doi:10.1186/s12893-023-02097-1.\u003c/li\u003e\n \u003cli\u003eVergara-Amador E, Quintero-Lozano JA, Linero-Lozano GA. Innervated digital artery perforator flap: a reliable and versatile technique for fingertip reconstruction. J Hand Surg Eur Vol. 2012;37(3):271-272. doi:10.1177/1753193411422685.\u003c/li\u003e\n \u003cli\u003eZhang H, Zhang F, Zhang H, et al. Analysis of risk factors for vascular crisis in thumb reconstruction with free toe flap. Microsurgery. 2019;39(8):732-737. doi:10.1002/micr.30495.\u003c/li\u003e\n \u003cli\u003eSebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128(3):723-737. doi:10.1097/PRS.0b013e31822b6747.\u003c/li\u003e\n \u003cli\u003eWong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010;32(9):1236-1245. doi:10.1002/hed.21284.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 \u003cstrong\u003eDemographic and clinical characteristics of 38 patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003ey\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAllen type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of surgery\u003c/strong\u003e（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003efollow-up\u003c/strong\u003e（M）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;VAS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMHQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;VSS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e( Reconstructed site)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVSS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Donor site )\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;2-PD（mm）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003escar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e4\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eInfection and non healing of bones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft middle finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;bulky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e6\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e7\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e8\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e9\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003escar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e10\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e11\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e12\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eleft index finger\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e13\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e14\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;bulky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e15\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e17\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eLeft middle finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e18\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e19\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e20\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;bulky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e21\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003escar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e22\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e23\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight middle finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e24\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e25\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cimg width=\"33\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAACEAAAAeCAYAAACiyHcXAAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAG0lEQVRIie3BMQEAAADCoPVPbQwfoAAAAICPAQ+WAAHiKAjgAAAAAElFTkSuQmCC\" v:shapes=\"文本框_3\" alt=\"image\"\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e27\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e28\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft middle finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e29\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;bulky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e30\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e31\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e32\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003escarring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e33\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e34\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eleft thumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003e35\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eRight index finger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Great toenail flap, Finger defect, Microsurgery, Functional recovery, Aesthetic outcome, Patient satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-9030463/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9030463/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGreat toenail flap transplantation is an effective technique for repairing finger soft tissue defects. This study aimed to evaluate the clinical efficacy and safety of microscopically-assisted total great toenail flap transplantation for finger defect reconstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe retrospectively analyzed 38 patients with Allen type II, III, or IV finger injuries treated between January 2022 and January 2025. All surgical procedures were performed under total microscopic assistance. Assessed parameters included flap survival rates, complications (such as infection and vascular crisis), aesthetic appearance evaluated using the Vancouver Scar Scale (VSS), and functional recovery measured via the Michigan Hand Outcomes Questionnaire (MHQ) and static two-point discrimination (2-PD) test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAll transplanted flaps survived. The complication rate was low, with only three minor incidents that were resolved through appropriate intervention. Reconstructed fingers demonstrated satisfactory aesthetic outcomes (mean VSS score: 3.4) and excellent functional recovery (mean MHQ score: 88.4; mean 2-PD score: 8.0 mm). Patient satisfaction was high, with a mean visual analog scale (VAS) score of 84.1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eTotal microscopic great toenail flap transplantation is an effective and safe technique for finger defect reconstruction, yielding significant improvements in aesthetic appearance, functional recovery, and patient satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Clinical Efficacy and Safety Evaluation of Total Microscopic Great Toenail Flap Transplantation for Finger Defect Reconstruction: A Retrospective Study of 38 Cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 07:54:45","doi":"10.21203/rs.3.rs-9030463/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39a90110-5e6c-40be-9420-88c7fe31ce7f","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-08T17:49:30+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T17:55:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 07:54:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9030463","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9030463","identity":"rs-9030463","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}