The aesthetic wrap-around flap technique for thumb reconstruction

Abstract

Objective In addition to restoring thuntb function in wrap-around flap transfer for thumb reconstruction, modification was done to improve the appearance of the reconstructed thumb and minimize donor site morbidity. Methods Thirty-nine thumb defects were reconstructed using Morrison＇ s procedure and modified great toe wrap-arotmd flap. The donor site was covered with free skin graft in 30 cases, with flap and skin graft in 8 eases and with flap in 1 case. Results Of the 39 transferred wrap-around flaps, 38 survived. One case failed. Postoperative follow up ranged from 3 months to 2 years. The reconstructed thumbs presented various degrees of reduction in diameters, thin skin and shallow fingerprint. Atrophy was most prominent in the nails. The mean static 2-point discrimination was 10 mm in the pulps. In 4 cases secondary skin graft or closure after partial phalanx resection was required to heal the wound of the donor great toe site. Wound healing was achieved in donor sites of the other cases. Most patients experienced mild pain of the donor foot during ambulation within the first 3 months after the surgery. Pain gradually disappeared when follow up interval exceeded 6 months. Standing, walking and nmning were near normal. Conclusion Attention should be paid to the design of bone construct, nail harvest and multiple nerve coaptations in wrap-around flap transfer. Modified flap harvest procedure reduces damage to the donor site and improves appearance of the reconstructed thumb. Key words: Transplantation ; Thumb; Microsurgery