Distal Thumb Research Articles

Disease severity versus pain severity: Range of motion differences during single- and multiplanar tasks in women with carpometacarpal osteoarthritis.

In carpometacarpal osteoarthritis (CMC OA) of the thumb, to what extent treatments should be directed by radiographic disease severity versus pain-based indicators remains an open question. To address this gap, this study investigated the relative impact of disease severity and pain severity on the range of motion in participants with CMC OA. We hypothesized larger differences would exist between extremes in the pain severity cohort than the disease severity cohort, suggesting pain modulates movement to a greater extent than joint degradation. Thirty-one female participants (64.6 ± 10.9 years) were grouped as symptomatic or asymptomatic (pain severity cohort) and early stage OA or end-stage OA (disease severity cohort) using radiographs and questionnaires. Kinematics were measured during single-planar and multiplanar range of motion tasks. Joint angle differences between groups were statistically compared. Differences in self-reported pain, function, and disability were evident in both participant cohorts. Notably, substantial distinctions emerged exclusively during multiplanar tasks, with a greater prevalence in the disease severity cohort compared to the pain severity cohort. Participants with end-stage OA also exhibited similar overall area covered during circumduction in comparison to those with early-stage OA, despite having a decreased range of motion at the CMC joint. The study underscores the importance of assessing multiplanar tasks, potentially leading to earlier identification of CMC OA. While movement compensations such as employing the distal thumb joints over the CMC joint were observed, delving deeper into the interplay between pain and movement could yield greater insight into the underlying factors steering these compensatory mechanisms.

Modified Bilhaut–Cloquet procedure for Wassel type III–IV polydactyly

BackgroundTo investigate the functional and aesthetic results of a new modified Bilhaut–Cloquet procedure for the treatment of Wassel type III–IV thumb polydactyly.MethodsThirteen patients with Wassel type III–IV thumb polydactyly who visited the Department of Orthopedics of Hebei Provincial Children's Hospital from 2019 to 2022 were selected. The surgical procedure involved a modified Bilhaut–Cloquet surgery, where two-thirds of the distal part of the dominant finger was retained as the p body of the reconstructed thumb. The triangular bone block of the ablated distal thumb that did not contain the epiphysis and articular cartilage was sutured and fixed, and the neurovascular flap of the ablated distal thumb was used as an augmenting segment of the reconstructed thumb, with the nail bed and nail matrix exquisitely sutured. The evaluation performed according to the Japanese Society for Surgery of the Hand (JSSH) system.ResultsAll 13 children showed bone healing, no wound infection, nonunion, or deformity healing. None of the children showed a significant reduction in the active and passive mobility of the thumb postoperatively compared with preoperatively. Postoperative evaluation was performed based on the JSSH score, with a mean of 17.15 points (14–19 points), with 11 children rated as excellent and two as good. No severe nail ridges, nail gaps, or nail split deformities of the thumb were observed postoperatively. Postoperative metacarpophalangeal and interphalangeal joint movements were not reduced compared with preoperative movements. All parents were satisfied with the appearance and function of the reconstructed thumb.ConclusionThe modified Bilhaut–Cloquet procedure designed in this study was satisfactory for Wassel type III–IV thumb polydactyly without affecting the stability of the interphalangeal joints and preserving joint mobility. The postoperative thumb has a comparable circumference and nail width and was cosmetically and functionally satisfactory, especially for the asymmetric two thumbs, which achieved favorable results.

Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction

Primary and secondary reconstruction of the thumb is a common reconstructive challenge for the hand and plastic surgeons. Currently, The kite flap or the First dorsal metacarpal artery flap remains the regular choice and is believed to be the best for distal thumb defects, but it’s the first time we have utilized a reverse homodigital dorsal radial flap for the thumb with an expected outcome. A 37 - year - old male patient suffered partially, obliquely, and radially necrotic thumb tip in the second week following conservation stitching of the wound due to a motorcycle accident. The necrotic tissues were desbrided and the residual defect was covered simultaneously by reverse homodigital dorsoradial flap. The Interphalange (IP) and Metacarpalphange (MCP) joints were flexible, and the active rang of motion (ROM) of the affected thumb was not limited at 3 months post - op. The reverse homodigital dorsoradial flap has become a useful and valuable material for thumb reconstruction. The flap provides acceptable aesthetic results with primary closure of the donor site and returns the essential functionality to the affected thumb.

Immediate Reconstruction of Distal Thumb Amputations Using Reverse Homodigital Dorsoradial Flap and the Amputated Part of the Phalanx

Immediate Reconstruction of Distal Thumb Amputations Using Reverse Homodigital Dorsoradial Flap and the Amputated Part of the Phalanx

First dorsal metacarpal artery flap in soft tissue reconstruction of recurrent thumb squamous cell carcinoma

Background. Subungual squamous cell carcinoma (SCC) of thumb is a rare disease. However, it is the most common malignancy affecting the nail bed. Early recognition is crucial and important for prompt diagnosis and effective treatment. Often this tumour needs to be treated surgically with wide local resection, which results in a defect in the thumb. If not handled appropriately, such defects render restriction in functionality of the involved thumb as well as a poor aesthetic outcome. In the worst-case scenario, it may result in a poor function of involved hand. Thus, reconstruction of the involved thumb is necessary. The main aim of reconstruction is to regain the hands' function and preserved the thumbs' sensation. Secondarily, to have an aesthetically pleasing hand. Our hands carry out delegate job and important duty for daily function. Especially, the thumb working together with the other fingers to carry out the hand function as one unit. Loss of thumb function affects the whole performance of the hand. Case descriptions. We report a case of recurrent subungual squamous cell carcinoma of thumb, which had wide local resection and subsequently underwent soft tissue coverage with an islanded first dorsal metacarpal artery (FDMA) perforator flap. One month after surgery, the patient was able to regain a good functional outcome of the hand. In this report, we discussed the procedures that had been done. Conclusion. The patient regained full functional hand after reconstruction with preserved sensation over distal thumb. The aesthetic outcome is satisfactory. The FDMA perforator flap is a very pliable and robust flap for reconstruction of distal thumb defect.

Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects

Background: Thumb defects induced by trauma lead to significant functional disability. The goal of this study was to identify the safety, versatility, and limitations, benefits, and functional outcomes, range of motion and reestablish sensory experience. These characteristics, in addition to a secure soft tissue cover, are needed for thumb restructuring. Study design: This was a retrospective study carried out in the Plastic Surgery Department of Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi from November 2021 to December 2022. Methods: The total 17 participants with traumic thumb defects which insert and treated with island flaps. The participants included 5 females and 12 males, the age group was 20-50 years and the average age (36 years). All patients were evaluated for the occurrence of early post-operative complications in terms of flap necrosis. Results: The operative time was 1 hours. The 15 participants underwent island FDMA flap except 2 participants which show necrosis but without again treatment recover. To evaluate the esthetic and functional outcome by Kapandji score, 2-PD, SS score and esthetic outcome follow by one year. Regarding the functional recovery Kapandji, 2-PD, the esthetic and subjective satisfactory score outcome was evaluated and show significant changes p<0.005. Conclusion: FDMA is one of the best choices for reconstituting distal thumb injuries, and it is a simple technique that has the potential to enhance the island's survival and lowering the rate of distal necrosis. The FDMA flap provides good functional results while causing little donor-site morbidity. Keywords: Cortical reorientation, Metacarpal artery, Island Flap, Two point discriminate.

Genetically Homogeneous or Heterogeneous Population - Distribution of the Recessive Allele in Selected Qualitative Characteristics of Selected Working-Age Population Sample.

The genetic structure of each population can be explained according to the frequency of genes and their allelic variants, genotypes, and phenotypes. To analyze the genetic heterogeneity of the working-age population from the area of Sarajevo Canton based on classic genetic markers. The studied parameters of genetic heterogeneity were assessed by the relative frequency of the recessive allele for static-morphological traits (earlobe shape, chin shape, hairiness of the middle digital phalanx, bending of the distal phalanx of the little finger and digital index) and dynamic-morphological traits (rolling of the tongue into a groove, extensibility of the proximal thumb knuckle, extensibility of the distal thumb knuckle, the way the forearms are crossed, and the way the fists are made). The results of the t-test showed a significant difference in the manifestation of the recessive homozygote for the observed parameters of qualitative variation in the subsamples of men and women. Only for two traits (attached earlobe and hyperextensibility of the distal knuckle of the thumb). The selected sample represent a relatively genetically homogenous population. This study serves as a valuable source of data for future research and the formation of a genetic database in Bosnia and Herzegovina.

Reverse homodigital dorsal wraparound flap for reconstruction of distal thumb

Reconstruction of degloving injury or amputation of distal thumb with no indication of replantation has always been a challenging problem for hand surgeons. In this study, a reverse homodigital dorsal wraparound flap innervated by the dorsal digital nerve was devised to repair degloving injury or amputation of distal thumb in 20 consecutive cases. In nine cases of thumb amputation, we skeletonized the phalanxes of the amputated part as a free cortical bone with Kirschner wires. All flaps survived uneventfully. The radiographs showed bone healing in all the patients of thumb amputation within 6 weeks postoperatively. At final follow-up, the appearance of the reconstructed thumb was acceptable and flap sensation and range of joint motion were satisfactory. This flap is a simple and reliable alternative method for degloving injury or amputation of distal thumb when replantation is impossible and patients refuse to donate tissues from toes. Type of study/level of evidence Therapeutic IV.

A swollen, discoloured thumb.

A woman aged in her 40s presented to Shanxi Provincial People's Hospital (Taiyuan, Shanxi, China) in January, 2020, with a 1-year history of a slowly swollen, discoloured, painful left distal thumb. No history of trauma or potentially systemic symptoms (eg, fever, cough, weight loss, or night sweats) was elicited. Physical examination showed a bulging thumbnail, clubbed fingertip, and a round, firm, immobile mass on palpation. There was abnormal 3 × 4 mm blue-black pigmentation at the lateral nail folds (figure, A). Joint mobilisation, skin temperature, and laboratory tests were normal. Radiograph showed a slightly expansile, ill-defined osteolytic lesion on the distal phalanx with cortical destruction and without matrix calcification or bony septae (figure, B).

Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases

BackgroundThe axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be suitable for cases over 10° flexion of fusion angle and extremely small-sized phalanx. Here, the authors describe the nonaxial multiple small screws (NMSS) technique, compare the mechanical strength of the NMSS technique with the AHCS technique, and suggest clinical outcomes of the NMSS technique.MethodsDIPJ and thumb IPJ arthrodesis models were simulated in the 4th generation composite bone hand. Fixation with three 1.5 mm cortical screws (NMSS) or one HCS (AHCS) was performed in each pair of the phalanx. The bending stiffness and load to failure were tested in 10 pairs of each specimen, and the torsional stiffness and torque to failure were tested in seven pairs of each specimen. Moreover, 15 consecutive clinical DIPJ and thumb IPJ arthrodesis cases were reviewed retrospectively.ResultsThe NMSS specimens showed significantly higher bending load to failure, torsional stiffness, and torque to failure than the AHCS specimens. All 15 arthrodesis cases were united without severe complications. The mean fusion angle was 16.3° for the nine cases of the flexed target position.ConclusionsThe NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required.

A Fabricated Force Glove That Measures Hand Forces during Activities of Daily Living

Understanding hand and wrist forces during activities of daily living (ADLs) are pertinent when modeling prosthetics/orthotics, preventing workplace-related injuries, and understanding movement patterns that make athletes, dancers, and musicians elite. The small size of the wrist, fingers, and numerous joints creates obstacles in accurately measuring these forces. In this study, 14 FlexiForce sensors were sewn into a glove in an attempt to capture forces applied by the fingers. Participants in this study wore the glove and performed grasp and key turn activities. The maximal forces produced in the study were 9 N at the distal middle finger phalanx and 24 N at the distal thumb phalanx, respectively, for the grasp and key turn activities. Results from this study will help in determining the minimal forces of the hand during ADLs so that appropriate actuators may be placed at the appropriate joints in exoskeletons, orthotics, and prosthetics.

Utility of "reposition-flap" in the reconstruction of the avulsed thumb.

Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to “sacrifice” another anatomical region for thumb reconstruction, the “reposition-flap” technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using “reposition-flap” with an O’Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge.

Background:Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem.Methods:This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature).Results:None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis.Conclusion:FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.

Repair of distal thumb degloving injury using combination of reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap

BackgroundTo examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury.MethodsTwelve patients with mechanical distal thumb degloving injuries were treated between February 2017 and August 2019. A combination of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap were used. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the joints, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were sequentially evaluated.ResultsTwo cases with postoperative flap blisters were treated at time of dressing changes up to successful scab formation. One case with postoperative arterial crisis of finger arterial dorsal branch vessel was successfully released in the pedicle. Ten cases healed by first intention and 2 cases by secondary intention. Twelve patients received follow-up examinations between 3 and 20 months (average 13 months) post-treatment, and all exhibited full, soft flaps with no fingertip pain.ConclusionThe combined use of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap is a practical and effective approach to surgical repair of distal thumb degloving injuries.

Cross-finger Flap to the Thumb: Quest for an Alternate Donor.

Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.

Our surgical technique to treat premature growth plate closure 7 years after toe-to-thumb transfer. A case report

In children, traumatic distal amputations of the thumb can be treated by partial first toe transfer. Growth is preserved by conserving a portion of the growth plate in the hallux distal phalanx. In the patient featured here, 7 years after such a distal thumb reconstruction, bone bridge resection was needed to restart growth and correct clinodactyly. When this patient was reviewed 4 years later, the thumb's longitudinal growth had been restored and continued.

Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation

Thumb reconstruction has always been challenging for hand surgeons. The disability can severely influence the working and social life of the patient, even if just the distal phalanx is affected. Revascularization is the best surgical option for incomplete distal amputation, although microsurgical reconstruction, sometimes, could be not feasible. A simple basic-skills-based reconstructive method, that takes into account the length preservation and a short recovery should be advocated. We treated 14 incomplete distal thumb amputations with bone exposure, classified as Hirase zone IIA-IIB. The distal thumb was held by a short tissue islet, nor neurovascular bundle, nor dorsal vein was included. Patients were assessed for skin and bone healing, length of thumb shortening, and time of return to full occupational activity. QDASH score was evaluated along with a two-point discrimination test. The outcome was fair in all 14 patients. Partial distal thumb necrosis was observed in six cases (40%); they healed by secondary intention. Finger shortening had a mean of 6.9 mm (range, 6–8 mm), mean interphalangeal joint motion was 48 degrees (range,45–55 degrees). The median static two-point discrimination was 7.1 mm (range, 6–9 mm), the mean quick DASH score was 1.8 (range, 0–4.5). All patients returned to work within a mean of 4.3 weeks (range, 4–5 weeks). The follow-up period was 12 months. Length preservation, fast recovery and easy return to manual work, above all, are the keystones of our successful procedure. Whether the revascularization is not executable, we provide a reliable and simple method to grant a functional thumb.

Arthrodesis of the Distal Interphalangeal Joint and the Thumb Interphalangeal Joint: A Retrospective Comparison of Kirschner Wires and the Acutrak 2 Headless Compression Screw

Background: Headless compression screws have become first choice for achieving arthrodesis in the distal interphalangeal joint and thumb interphalangeal joint. Only few comparisons between headless compression screws and other methods have been published. Objective: To assess healing and complication rate after arthrodesis of the distal interphalangeal joint or the thumb interphalangeal joint using a headless compression screw or Kirschner wires. Methods: A retrospective analysis of 148 consecutive primary fusions performed with the Acutrak 2 headless compression screw (n=107) or K-wires (n=41) was conducted. Healing was assessed clinically and radiographically at 6 to 8 weeks postoperatively. Results: In 89% of cases fusion had been achieved at 6 to 8 weeks postoperatively using the headless compression screw. 7 cases healed after 8 weeks. Secondary surgery with screw removal was required in 11 cases due to screw prominence, infection or non-union. In 71% of cases fusion had been achieved at 6 to 8 weeks postoperatively using Kirschner wires showing a lower fusion rate at this stage as compared to the headless compression screw group (p<0.05). 9 joints in the Kirschner wire group fused at some point after 8 weeks of follow up yielding a total fusion rate of 93% which was similar to 96% in the headless compression screw group (p>0.05). One infection occurred in the Kirschner wire group. Conclusion: Arthrodesis can be achieved with either a headless compression screw or Kirschner wires both showing equivalent total fusion rates though fusion may occur earlier using a headless compression screw.

Anatomical study and clinical application of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects

Objective To explore the anatomic basis of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects and report its clinical efficacy. Methods Microsurgical anatomical study was performed in 6 specimens of fresh Chinese adult lower extremities to observe and measure the branches, distribution, vessel length, caliber and venous valve characteristics of the anterior lateral malleolar venous network. From May 2007 to February 2017, 15 patients with superficial palmar arch defects were treated by anterior lateral malleolar venous network graft. Results Anatomical study results showed that there was a obviously visible venous network in the superficial fascia of the anterior lateral malleolus. The distal end was originated from the fibular side of the arcus venosus dorsalis pedis, and the proximal vessels flowed into the great saphenous vein medially and the small saphenous vein laterally. Between them, there were 4 to 6 fine veins that formed network. The length of the distal dorsal segment of small saphenous vein (BC) was (2.81±0.39) cm. The branch length of the anterior lateral malleolar venous network (CD) was (5.32±0.92) cm. The fibular side vascular diameter of arcus venosus dorsalis pedis was (2.15±0.35) mm. The proximal end of the vascular network had 4.8 branches. The diameter of the vascular branch at the tip of the lateral malleolus E line horizon averaged (1.06±0.43) mm. There are an average of 4.2 valves per anterior lateral malleolar venous network. The valves in branches are toward the proximal direction. Clinically, 15 cases of superficial palmar arch defects were treated by anterior lateral malleolar venous network graft with a total of 54 anastomosis sites of distal area of recipient area and an average of 3.6 anastomosis sites per case. Postoperatively, 1 case suffered partial distal thumb necrosis and the rest of the distal fingers survived uneventfully. The follow-up time ranged from 6 months to 5 years and 3 months in 12 cases. The appearance of the hand was good, and the function of holding and opposition movement was restored. The finger proprioceptive sense was recovered. The two-point discrimination was 5 to 7 mm. According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 6 cases, good in 4 cases, fair in 1 case and poor in 1 case. There was no influence on the function of donor site. Conclusion The anatomy of anterior lateral malleolar venous network is constant. Its shape, diameter and number of branches are similar to the superficial palmar arch. The valve opening is toward the proximal end. It is an ideal method for repairing the defects of superficial palmar arch. Key words: Dissection; Vascular grafting; Venous network; Superficial palmar arch

Repair of soft tissue defect in distal thumb with dorsal thumb neurocutaneous vascular flap

Objective To evaluate the surgical methods and clinical effects of the reconstruction of soft tissue defect in distal thumbwith dorsal thumb neurocutaneous vascular flap. Methods From January, 2014 to December, 2016, 32 patients with soft tissue defects of distal thumb were repaired with dorsal thumb neurocutaneous vascular flaps, including left thumbs in 11 cases and right thumbs in 21 cases. They were including 7 cases of nail bed defects, 9 cases of pulp defects under nails, 16 cases ofthe defects of tips or stump of fingers; skin and soft tissue defects range of 1.5 cm×1.0 cm-3.5 cm×3.2 cm; Flap cutting areas range of 2.0 cm×1.5 cm-4.0 cm×3.5 cm. If the donor areas could be sutured directly, be sutured; if they could not, be covered with intermediate split thickness skin grafts. All patients were followed up when they were reviewed in outpatient department, and to be evaluated the shape, texture, sensation, flexion and extension function, and donor site of the flaps. Results One case of flaps blood circulation disordereddue to tight suture, and eased after the removal of part of the sutures; One case of flaps atrophied, and the phalangette was exposed after 3 months, so we removed the end part of bone and the wound was closed; other flaps were survived, with primary wound healing. In the total 32 patients, they were followed up range of 3 to 36 months,with an average of 12 months. Eighteen cases were followed up at least 6 months, which were 4 of the 7 cases of nail bed defects, 5 of the 9 cases of pulp defects under nail and 9 of the 16 cases of the defects of tip or stump of fingers. The appearances and textures of flaps were good, protective sensations were restored, and skin flap two-point discrimina-tionswere 8-10 mm. According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery, it was excellent in 11 cases, good in 17 cases and moderate in 4 cases, with the excellent and good rate of 87.5%. Conclusion It has advantages of simple operation, low risk, high success rate and satisfactory curative effects of the use of dorsal thumb neurocutaneous vascular flap for repair of distal thumb defect of skin and soft tissue. It is not only suitable for the hospital with good technical and equipment, but also suitable for the primary hospital. Key words: Finger injury; Thumb; Neurocutaneous vascular flap; Microsurgical operation