Thumb reconstruction using wrap-around flap from the big toe with the distal phalanx and the skin island of the second toe: a clinical study

Abstract

Objective To evaluate the effect of modified full thumb reconstruction using wrap-around flap from the big toe alone with its distal phalanx and the skin island of the second toe for type ]I B thumb defect. Methods We applied a wrap-around flap including the distal phalanx from the great toe with the second toe dements including bones, tendons and skin to form a composite flap based on the same vascular pedicle for thumb reconstruction in 6 cases of type 11 B thumb defect. Results All of the 6 thumbs survived completely. Postoperative follow-up period ranged from 6 to 24 months. All the reconstructed thumbs and donor big toes had satisfactory appearances. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 4 cases and good in 2 cases. All the patients could manage their activities of daily living independently. Five patients returned to work. Conclusion Modified full reconstruction using wrap-around flap from the big toe alone with its distal phalanx and the skin island from the second toe for type 11 B thumb defect can not only restore the realistic configuration and sensation of the thumb, especially of the distal segment, but also enhance bone healing and recover the range of motion of the thumb. Donor site morbidity is acceptable. Key words: Thumb; Finger injuries; Tissue transplantation; Reconstruction