Donor Foot Research Articles

REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY

To investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. Between September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. Nine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. The medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.

Transplantation of free proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis

Objective To evaluate the clinical outcome of reconstruction of traumatic digital arthritis by transfer of free proximal interphalangeal joint of the second toe with toe reserving technique. Methods The study enrolled nineteen patients with traumatic digital arthritis treated from May 2013 to April 2016. The patients consisted of fifteen males and four females, and mean age was 27.3 years (range, 18-52 years). Finger involved included index fingers in 10 patients, middle fingers in seven and ring fingers in two. The joint of digit was reconstructed by transplanting the proximal interphalangeal joint of the second toe with a monitoring flap, and bone defect of the second toe was repaired with autogenous iliac bone graft. Wound was closed directly in six patients and covered by island flap from the foot dorsum in 13 patients. Evaluation indicators contained survival rate of the free joint and island flap, appearance and fracture healing of the finger and toe and motion of the proximal digital joint. Finger function was studied using the evaluation standard of upper limb function set up by hand surgery branch of Chinese Medical Association. Healing in the donor site, foot function and related complications were observed. Results All the free joint and island flap survived. Period of follow-up was 6-30 months (mean, 14 months). The fractured finger healed at 2.5 months on average, and appearance of the finger was good. Flexion range of the proximal digital joint was 63°-80°(mean, 74°) and extension range was -20°--10°(mean, -14°). Finger function was excellent in eleven patients and good in eight patients, with the excellent-good rate of 100%. Hematoma of the dorsal region of the foot occurred in one patient and the cut healed well after taking out some stitches and drainage. All fractured toe healed at 2.6 months. Except that one patient had fracture malunion with minor outward inclination, all presented good appearance of the toe without influencing walking and running. On the part of iliac, there was only one inconspicuous linear scar without any discomfort. Conclusions Transfer of free proximal interphalangeal joint of the second toe with toe preservation restores the anatomy structure and function of the digital joint. Meantime, autogenous iliac bone grafting combined with island flap from the foot dorsum for coverage of donor site defect retains the toe length and reduces injury of the donor site. Key words: Finger joint; Arthritis, traumatic; Toe phalanges; Bone transplantation

EFFECT OF SECOND TOE-TO-HAND TRANSFER ON THE PLANTAR PRESSURE DISTRIBUTION OF THE DONOR FOOT.

ABSTRACTObjective: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. Methods: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. Results: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). Conclusions: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study.

Long-Term Follow-Up on the Donor Foot After Thumb Reconstruction Using Big Toe Wrap-Around Flap in Two Different Operation Methods.

The function of the donor foot has been affected after using big toe wrap-around flap for thumb reconstruction. A modified operation method has been developed to reduce the adverse effect on the donor foot. The current study compared the long-term effect of the classic and the modified operation methods on the donor foot. Gait analysis was carried out, including how the patient walked, the walking speed and walking distance, and how the patient jumped and ran. Plantar pressure was measured while the patient was standing and moving. A total of 45 patients who received the 2 different operation methods were included. The follow-up time was 4-10years with a mean of 6.5years. Various degrees of complications occurred for the 21 patients who received the classic operation method. For these patients, plantar pressure of the donor foot was obviously different comparing with the healthy unaffected foot while the patient was standing or walking. For the 24 patients who received the modified operation method, no obvious complications were observed and the plantar pressure of the donor foot and the healthy unaffected foot was similar while the patient was standing or walking. In conclusion, both the classic and the modified operation methods have affected the function of the donor foot after using the big toe wrap-around flap for thumb reconstruction. However, the donor foot was less affected when the modified operation method was used.

A new method of finger / thumb reconstruction using composite tissue

This article presents authors’ methods of digital reconstruction using composite tissue transfer. The authors present their approach to achieve the goal of restoring full cosmetic appearance of the reconstructed toes while preserving the function and cosmetic appearance of the donor foot. The reconstructive procedures for each degree of digit defect are discussed in detail, and pitfalls and technical tips are given. The article is a summary of the authors’ experience in reconstruction of 646 digits since 1998 and the challenges we faced in the complex microsurgical reconstruction necessary in pursuing the goal of restoring the cosmetic appearance of reconstructed digits and donor feet. 1. We present our methods of digital reconstruction using composite tissue transfer. 2. Our major aims of surgery are to improve the cosmetic appearance of reconstructed hands and donor feet. 3. We describe a number of methods using modified or novel designs for composite tissue transfer from the foot to improve cosmetic appearance of the reconstructed digits and to improve both the cosmetic appearance and function of donor feet. 4. The article provides technical details of the methods we used to move closer to an ideal reconstruction of digits and minimizing donor foot morbidity.

Foot Web Free Flaps for Single-Stage Reconstruction of Hand Webs

To present a method for reconstructing the digital web in posttraumatic defects using a free tissue transfer of the web from the foot and to present the functional and aesthetic results. Nine web free flaps were performed; 8 were used to reconstruct posttraumatic web losses and 1 was used to reconstruct a defect resulting from to infection. All cases involved the first (3) or second (6) webs of the hand. Web flaps were taken from the foot first web (2patients), from the second (6 cases), and from the third (1 case) in a patient with congenital syndactyly of second foot web space. The donor site was managed by skin grafting from the instep (1 case), creation of a syndactyly (7 cases), or both (1 case). All flaps survived without complications. Finger abduction and flexion-extension were similar to the contralateral side. No functional limitations, pain, or contracture were reported. One donor site healed with hypertrophic scars; otherwise, no donor site complications occurred. On a visual analog scale (0-10), the patient assessed appearance of the hand and the donor foot as 9.0 and 9.0, respectively, on average. One web was not well-positioned in the first operation and required revision. The foot web free flap reconstructs the hand web by replacing it with a similar functional subunit rather than attempting to recreate the complex geometry, and allows for full function and excellent appearance of the hand. Therapeutic IV.

Coverage of donor site defects on dorsum of the foot after dorsalis pedis flap transfer with pedicled lateral supramalleolar artery flaps

Objective To investigate the clinical application of pedicled for coverage of donor site defects resulted from dorsalis pedis flap transfer.Methods From October 2008 to September 2012,the flap pedicled on the lateral supramalleolar artery was reverse transferred to cover the defect on the dorsum of the foot resulted from dorsalis pedis flap harvest in 11 cases.Among these cases 6 had second toe combined with dorsalis pedis flap transfer and 5 had dorsalis pedis flap transfer.Postoperatively the appearance of the flaps,pain and touch sensation,temperature perception and two-point discrimination were evaluated.AOFAS assessment of donor foot function was performed.Results Flaps of the 11 cases all completely survived.Primary wound healing was achieved at the flap donor site.Nine cases were follow-up for 12 to 24 months while 2 were lost to follow-up.The flaps had good appearance.There were no excessive scar,pain or ulcer.The patients were satisfied with the aesthetic results.Perception of pain,temperature and touch was restored.At 12 months postoperatively,twopoint discrimination was (10.1 ± 2.2) mm on average.Sensory recovery was S3+,while the mean foot and ankle AOFAS score was 90.7.Conclusion Reverse transfer of pedicled lateral supramalleolar artery flap is a good option for coverage of dorsum foot soft tissue defect.It reduces donor site morbidity and restores good appearance and function of the donor foot. Key words: Surgical flaps; Transplantation; Donor site; Repair

Medial plantar flap to repair defects of palm volar skin.

The methods of repairing defects in fingers, volar skin of the palm and soft tissue were investigated. From 2010 to the present, we examined 12 cases in which medial plantar skin flaps were used to repair defects in the fingers and palm. According to skin and soft tissue defects in the fingers and palm, a flap was designed using the medial plantar artery as the vessel pedicle. The flap was dissected and isolated between the abductor hallucis and flexor digitorum brevis, and transplanted to the hand. We then observed the skin colour, skin texture and tactile sensitivity of the hand, as well as the shape and function of the foot. Follow-up for 3-28 months showed that the flaps survived in all 12 cases, with soft skin, healthy appearance, colour consistent with the palm skin and no pigmentation. The two-point discrimination was 5-7 mm. The donor foot functioned well, and the scar at the donor site was slight and had an aesthetic appearance. The free medial plantar flap is an ideal flap for repairing soft tissue defects in the palm.

Outcome of free flap vascularized by the dorsal artery of big toe in treating finger skin defect

Objective To evaluate the outcome of the procedure of using the free flap vascularized by the dorsal artery of big toe to treat finger skin defect. Methods From August 2010 to April 2013, 21 cases of finger shin defect were treated with the free flap vascularized by the dorsal artery of big toe in which emergency surgeries were conducted in 9 cases and sub emergency surgeries were conducted in 12 cases. The age of the 21 patients was 21 to 48 years old and 15 of them were males and 6 were females. Thumb was involved in 6 patients and index finger was involved in 15 patients. The skin defect occurred at dorsal in 7 patients and palm in 14 patients. The area of the flaps ranged from 2. 2 cm x 1.6 cm to 4. 0 cm ~ 3.2 cm. Observed the restoration of the affected fingers＇ appearance and function, investigated the clinical results and concluded the indication and advantages and disadvantages of this procedure by following up. Results All of the 21 flaps survived at the last office visit. The follow-up period ranged from 3 to 18 months. The shapes and the fingerprints of the flaps were satisfied. The color and texture of the flaps were similar to those of the finger skin. The 2 points discriminations of the flaps was 6-8 mm. No function deficits were found in the donor feet. Conclusion This free flap is satisfied in the shape, easy to harvested and the blood supply was constant in its location, and recommend it in treating the small of middle area skin defect in the finger. Key words: Dorsal flap of big toe; Finger; Transplantation; Microsurgical operation

Long-term effects of toe transfers on the donor feet

The purpose of this study was to assess the long-term consequences to the donor site of microvascular transfer of one or two toes. This was achieved retrospectively by patient-reported, clinician-based and functional testing. Weight-bearing radiographs were taken of both feet. Seventy-four patients (80 feet, 84 transferred toes) participated in this study. After a median of 16 years follow-up, most patients reported no or only minor complaints concerning the donor site. Cold intolerance and pain during exertion were the most commonly reported complaints. According to the two functional scores used, 92% of patients reported no or minor complaint and 83% of patients received a good result at the donor feet. Maintaining first ray alignment and avoiding early postoperative complications predicted a better outcome. Even though donor site ramifications should be expected after microvascular transfer of toes, patient satisfaction remains high.

The application of hallux dorsal artery flap for repairing f＇mger pulp defect

Objective To investigate the clinical efiqcacy of repairing finger pulp defect with hallux dorsal artery flap. Methods Finger pulp defect in 11 cases was treated with free transplantation of hallux dorsal artery flap. Flap sizes ranged from 2.0 cm × 1.5 cm to 3.5 cm× 2.5 cm. Results Flap survival was uneventful in 10 cases. Vascular crisis occurred in 1 flap. Surgical exploration and reanastomosis of the vessels rescued the flap that survived. The patients were follow-up for 1 month to 2 years. The appearance and texture of 10 flaps were satisfactory. Two-point discrimination was 5 to 8 nun. All affected fingers had normal pinch. Bulkiness and stiffness of the flap was treated with plastic surgery which greatly improved flap appearance in 2 cases. Walking of the donor foot was normal. Conclusion Hallux dorsal artery flap transplantation leads to good clinical results and is an ideal flap for repairing of finger pulp defects. Key words: Finger injuries; Surgical flaps; Microsurgery

Facial Reanimation by One-Stage Microneurovascular Free Abductor Hallucis Muscle Transplantation

In 1990, Jiang Hua introduced a new method using one-stage reconstruction with free abductor hallucis muscle transfer for dynamic reanimation of established unilateral facial paralysis. The authors present their experience with this procedure and analyze the postoperative complications and long-term functional and aesthetic outcomes. From March of 1990 to March of 2010, 45 patients underwent the free abductor hallucis muscle transfer procedure in the authors' department. Forty-one were followed up for 54.6 months (range, 28 months to 17 years). The Toronto Facial Grading System and Facial Nerve Function Index were used to evaluate facial nerve function at 2 years after surgery and last follow-up. Complications and function of the donor foot were analyzed. No postoperative mortality was found. Complications occurred in four of 41 patients, including muscle loss, infection, hematoma, and hypertrophic scar. The others obtained satisfactory symmetric faces in the static state and in voluntary contraction of the transferred muscles. Mean values for the Toronto Facial Grading System (50.6±7.8) and the Facial Nerve Function Index (65.7±11.4 percent) were significantly higher at 2 years postoperatively in comparison with preoperative status (21.2±5.3 and 19.5±3.6 percent, respectively) (p<0.05). Long-term outcomes (Toronto Facial Grading System, 54.8±6.9; Facial Nerve Function Index, 79.4±9.6 percent) were awarded higher values than early outcomes shown at 2 years postoperatively (p<0.05). Free abductor hallucis muscle transfer is safe and effective in dynamic reanimation of longstanding unilateral facial paralysis. Favorable long-term results demonstrate that the authors' technique is an alternative method for facial reanimation. Therapeutic, IV.

Using modified great toe wrap-around flap to reconstruct degloved thumb and fingers

Objective To explore the clinical outcome of using modified great toe wrap-around flap to reconstruct degloved thumb and fingers. Methods Eighteen patients were involved. Based on different types of injury, four procedures were carried on for reconstructing degloved thumb and fingers： ①Unilateral modified great toe wrap-around flap to reconstruct 9 degloved thumbs of distal proximal level and 3 degloved fingers of proximal interphalangeal joint level. ②Unilateral modified great toe wrap-around flap with second toe medial flap to reconstruct 2 total degloved fingers. ③Bilateral modified great toe wrap-around flap to reconstruct 2 thumbs. ④Bilateral modified great toe wrap-around flap and second toe medial flap with neurolized super thin anterolateral thigh flap to reconstruct 12 degloved fingers. This wrap-around flap carried with entire nail. A triangle flap was reserved at medial plantar of great toe. Results All free flaps were survived in one stage. Fifteen patients were followed up for 8 to 25 months. The contour of reconstructed digit was as same as eontralateral digit with satisfactory motion are and sensation. There was no extensive sear in donor toe. The width of medial plantar triangle flap increased significantly. All patients could walking, running, jumping without restricted. Conclusions With reconstructed by modified great toe wrap-around flap, degloved thumb or finger can be promised with excellent contour and function outcome. In the meantime, the loss of donor foot can be expected to minimal. This procedure is one of the best ways for reconstructing degloved thumb and finger. Key words: Toe ; Great toe wrap-around flap ; Finger ; Degloved digit ; Mierosurgery

Donor Foot Morbidity Following Modified Wraparound Flap for Thumb Reconstruction: A Follow-Up of 69 Cases

To evaluate donor foot morbidity after thumb reconstruction using a modified wraparound flap. We observed patients who accepted thumb reconstruction with the modified wraparound flap between January 2001 and December 2009. We examined and evaluated the reconstructed thumb and donor foot. Donor morbidity was assessed on both a subjective and an objective basis using the Foot Function Index-verbal rating scales (FFI-5pt), the American Orthopaedic Foot and Ankle Society for Hallux Metatarsophalangeal-Interphalangeal (MTP-IP) scale, and gait analysis and dynamic pedodynographic measurements. We reviewed 69 patients; the follow-up period ranged from 6 months to 5 years, with an average of 26 months. The reconstructed thumbs had good aesthetic appearance, and static 2-point discrimination averaged 9.4 ± 2.7 mm. Full length or most of the length of the donor toes was preserved in 67 patients. The retained plantar strip was significantly enlarged from an average of 14.5 ± 1.4 mm measured at surgery to 27.8 ± 4.7 mm measured at last follow-up (p < .05), and its 2-point discrimination was 9.1 ± 2.3 mm. A total of 34 patients were available for FFI-5pt and Hallux MTP-IP scale evaluation. The FFI-5pt total score was 3.1 ± 2.7 and the total Hallux MTP-IP score was 87.9 ± 7.1. Gait analysis and dynamic pedodynographic measurements were available in 20 patients. All 5 biomechanical parameters (timing, trajectory, symmetry, average peak force, and peak pressure between donor foot and the contralateral foot) had no significant difference. The function of the donor foot after a modified wraparound flap for thumb reconstruction was well preserved, the degree of pain and disability in the donor foot was mild, and foot function in gait was not disturbed. Although a certain degree of restriction in interphalangeal joint motion occurred, this was nearly negligible and did not deter return to normal daily living activity, work, and recreation.

Aesthetic Refinements in Second Toe-to-Thumb Transfer Surgery

Second toe-to-thumb transfer is a good alternative to using the great toe for reconstruction of the thumb. It achieves excellent function and reduces morbidity to the donor foot. However, cosmesis is often poor. The second toe has three unattractive features, a narrow "neck," a bulbous tip, and a short nail. The authors describe a modified second toe transfer that addresses cosmesis in six patients. These include (1) harvesting a flap from the adjacent side of the great toe and insetting it into the volar aspect of the second toe to give more bulk, (2) making skin excisions on each side of the tip to reduce the bulbous appearance, and (3) excising the eponychium to produce apparent lengthening of the nail. The mean follow-up period was 18 months (range, 6 to 36 months). The procedure resulted in good function and improved cosmesis in all six cases. Part of the great toe flap was lost in one case. The mean two-point discrimination in the transferred toes was 10.1 mm, with protective sensation present in the flaps. The range of motion of the transferred toe was 14 to 38 degrees at the metatarsophalangeal joint, 16 to 55 degrees at the proximal interphalangeal joints, and 20 to 36 degrees in the distal interphalangeal joints. All patients except one were happy with the appearance of the transferred toe. This novel approach will allow patients to take advantage of the lower morbidity to the donor site afforded by second toe-to-thumb transfer and provide the patients with a more aesthetic appearance of the new thumb.

Long-term functional results of microvascular toe-to-thumb reconstruction

The purpose of this study was to evaluate the long-term functional results of microvascular toe-to-thumb reconstruction after trauma. Forty-one patients meeting the inclusion criteria were available for a clinical follow-up study. The function of the hand was assessed with questionnaires as well as with modified Tamai and Sollerman hand function tests. According to the questionnaires, most activities were considered easy or quite easy and the majority of the patients (36/41) managed with no or minor complaints. Clinical tests showed good recovery of function. Patient satisfaction was high. There were superficial infections in five hands and in six donor feet. In total, 16 late corrective operations were done to eight patients. Microvascular toe transfer is a good option for grip reconstruction after thumb amputation. The extent of the initial injury influences the achievable outcome, yet even a single toe transfer can restore adequate grip function.

Effecacy analysis on finger reconstruction by transplantation of two second toes

Objective To study the clinical application of finger reconstruction by transplantation of two second toes and evaluate the postoperative appearance and function regarding the reconstructed hand and donor feet. Methods Defect of fingers were treated by transplantation and reconstruction with a total of 74 cases,including two second toes transplantation for both thumbs in 2 cases,thumb with index finger in 10 cas es, index finger with middle finger in 8 cases and middle finger with ring finger in 17 cases. Results Sevetythree fingers survived except 1 failed. During the follow up examination made from 3 to 36 months, the reconstructed fingers could move, write and dress with ease, pinch forcefully, show good recovery of manual work and the sensation of pain and warmth. Two-point discrimination found to be between 5 to 10 mm. Both donor feet have symmetrical appearance with normal gait and satisfactory motion. Also, no pain was complained.Conclusion Transplantation of two second toes from both feet is a good method to reconstruct defect of multiple fingers, and has little effect on the appearance and motion of feet. Key words: Second toe; Transplantation; Finger reconstruction; Microsurgery

Wide thumb and the first web reconstruction using a neurovascularised instep free flap

Deformed hands result in palmar defects of the thumb. The sensate instep free flap can be used for wide palmar coverage of the thumb. Three hands with palmar defects of the thumb extended to the first web space underwent soft-tissue reconstruction using a neurovascular instep free flap. These flaps provided sensate coverage with static two-point discrimination values of 8-15 mm. Key pinch strengths of reconstructed thumbs were nearly half of those on the normal side. Donor foot morbidity was minimal with no hyperkeratosis. The neurovascular instep free flap supplies sensate, similar pliable and tough glabrous skin to the palmar surface of the thumb extended to the first web area.

Composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects

Objective To introduce the clinical application of composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects. Methods This method was applied to treat 7 cases and 19 fingers. All the cases involved complex dorsal soft tissue defect of 2 to 4 fingers with extensor tendons missing and phalanx or interphalangeal joint exposed. The combined soft tissue defect area was 5.0cm×1.5cm to 9.0 cm× 2.5 cm. The flaps were designed along the axis extending from the fibular and plantar margin of the great toe to the interspace between the first and second metatarsal bones. The flap was slightly larger than the dorsal finger defect combined and the shape of the flap was the same as the combined defect. The greater saphenous vein, dorsal digital veins and dorsal metatarsal or plantar metatarsal artery and nerves were included in the flap. They were sutured with dorsal digital veins, digital artery and nerves, respectively. Extensor digitorum brevis tendons and extensor digitorum longus tendons were included in the flap to reconstruct the missing tendons. Results All the flaps survived with good texture and good appearance. Two-point discrimination recovered 6 to 8 mm. Finger extension function was restored, and active finger flexion and extension recovered satisfactorily. The donor feet were with slight scar, good appearance and normal function. Conclusion Combined dorsalis pedis,toe web and great toe fibular flap including extensor digitorum brevis and extensor digitorum longus tendon is a good option to treat multi-finger dorsal complex defects. Key words: Surgical flaps; Finger injuries; Tendon injuries; Transplantation

The aesthetic wrap-around flap technique for thumb reconstruction

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