Abstract
BackgroundThe thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction.MethodsFrom January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after 1, 3 and 6 months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically.ResultsTwenty-nine cases of thumb reconstruction recovered well. After following up for 6–15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6–8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before the operation, the biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head.ConclusionsThis study confirmed that the toenail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc., can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation.Trial registrationClinicaltrials.gov, NCT03879941; registered on 10 March 2019, retrospectively.
Highlights
The thumb accounts for 50% of the total hand function
Traumatic thumb defect is a common injury in hand surgery
Since Morrison et al [5] first used the free toenail flap to wrap the tibial block for thumb reconstruction in 1980, the technique has been widely used clinically
Summary
The thumb accounts for 50% of the total hand function. Traumatic thumb defect is a common injury in hand surgery. Many traditional repair methods for the treatment of second-degree thumb defects are available, such as lengthening the stump, repairing the skin tube after iliac bone grafting and reconstructing the thumb with free. Compared with the common toe transplantation for thumb reconstruction, the toenail flap with the distal phalangeal bone does not sacrifice the toe, has less influence on the function of the foot and is close to the normal appearance of the thumb. Repeated friction causes erosion of the skin grafting area and leads to the long-term formation of a thick callus, affecting the weight of the donor foot and normal walking, and plantar stress distribution changes [6]. Many scholars believe that the success criterion of toenail flap transplantation should be the survival of the flap itself and the effect on the feeding function
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