Subtotal reconstruction of the thumb. (Tubed-pedicle flaps with tactile restoration)

Abstract

The thumb is the most important single digit of the hand. Thumb loss, total or partial, is a disastrous injury to the manual worker. The loss of the thumb at the metacarpophalangeal joint decreases the effectiveness of the hand by 40%. 1 Reconstruction of thumb loss proximal to the metacarpophalangeal joint can be accomplished most effectively by digital transfer, preferably of the index finger. The neurovascular pedicle method, developed by Littler, is the method of choice. 2 The surgeon confronted with the problem of loss at the metacarpophalangeal joint or through the proximal phalanx may feel that the sacrifice of a normal digit to reconstruct the thumb is unwarranted. It is in this type of case that the tubed-pedicle flap and bone graft is most suitable. This type of reconstruction is particularly applicable when some type of pedicle flap must be used to obtain primary closure in order to avoid