Osteotomy for Thumb Metacarpal Lengthening

Abstract

Reconstruction of acquired traumatic amputations at the level of the middle third of the thumb may be accomplished by pollicization of an injured or partially amputated digit, the cocked-hat flap, metacarpal lengthening, or osteoplastic reconstruction techniques that involve a bone graft covered by a tubed pedicle flap and an island pedicle flap. Particularly in the absence of another injured or partially amputated digit, metacarpal lengthening followed by a second-stage bone grafting procedure and deepening of the web space with phalangization of the remaining thumb at the same time provides an excellent method of managing this devastating injury (Figs. 57-1 A Figs. 57-1 B Figs. 571-1 C Figs. 571-1 D-N). The purpose of this operation is to restore length and mobility to oppose other digits. In addition, the reconstructed thumb should have adequate sensation, stability to allow strong resistance without collapse, and freedom from pain.