Thumb Reconstruction Research Articles

The Versatility of the Superficial Circumflex Iliac Artery Perforator Flap: A Single Surgeon's 16-Year Experience for Limb Reconstruction and a Systematic Review.

The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option of free tissue transfer for small to large defects. In this study, we examine the advantages of the SCIP flap, its cadaveric anatomy, and clinical subtypes. Ten cadavers were dissected and the corresponding pedicles of the SCIP and groin flaps were identified. A retrospective review of 20 clinical cases of free SCIP flap reconstruction was undertaken. The indication for reconstruction, flap dimensions, and survival were analyzed. A systematic literature review was conducted including articles that have previously reported the use of the SCIP flap. The SCIP pedicle was present in all our cadaveric dissections. The starting point of its pedicle ranged from 1.5 to 4.5 cm along the superficial circumflex iliac artery. The median diameter of the perforator and its concomitant vein was 1mm (range 0.8-2 mm). A cutaneous vein (1.3-2.3 mm) could be included in the flap if the concomitant vein was too small. Twenty consecutive patients had free SCIP flaps between 2002 and 2018. The indications were for finger defects (n = 8), thumb reconstruction (n = 1), lower limb compound fractures (n = 3), iatrogenic wounds (n = 2), upper limb large defects (n = 2), and scar contractures (n = 4). Flap dimensions ranged from 2 × 4 cm to 14 × 25cm, and the longest pedicle was 8cm. All flaps survived. The systematic literature review identified 34 previous reports using the SCIP flaps, most of these published by Asian units. The SCIP flap is useful for reconstruction throughout the body due to its ease of dissection, thinness, adjustable pedicle length, and flap dimension ranging from tiny to large, as well as the feasibility of raising a compound flap incorporating an adipofascial or vascularized bone component if necessary.This is a level of evidence therapeutic IV study.

Distraction Lengthening of First Metacarpal in Traumatic Thumb Amputations.

Introduction Based on the level of the thumb loss, phalangization, toe-to-thumb transfer, pollicization, and distraction callotasis of the first metacarpal are the various options available for reconstruction. The aims of the study were to observe the length gained in the distraction process, duration of treatment required, functional recovery in the form of pinch strength, sensations, and patient satisfaction. Patients and Methods It was a prospective study of 10 patients of thumb amputation, conducted from January 2014 to July 2015. The patients’ age, mode of injury, level of amputation, and advantages and disadvantages of distraction callotasis were evaluated. Results The most common etiology of thumb loss was domestic accidents while working with a chaff cutter. The total duration of treatment was 124 (93–165) days and the mean gain in length was 25 (20–28) mm. The pinch strength increased from a mean of 0.91 to 2.06 kg, i.e., a 44.17% improvement from preoperative pinch strength. All of our patients retained their sensations of the reconstructed thumb post distraction. Conclusions Among many options for thumb reconstruction, distraction callotasis is a simple and safer option in the selective group of patients who are not keen on toe-to-thumb transfer which provide a significant improvement. The longer duration of treatment is the disadvantage associated with the need for proper counselling beforehand.

Resorption of Iliac Bone Grafts Following Wrap-Around Flap for Thumb Reconstruction: A Follow-Up Study

To study the bone resorption pattern of iliac crest grafts after thumb reconstruction with a wrap-around flap from the hallux. Patients who underwent thumb reconstruction with a wrap-around flap from the hallux were followed up. We measured the length, proximal, middle, and distal widths, and proximal, middle, and distal thicknesses of the iliac crest grafts on posteroanterior and lateral radiographs and used the length, width, and thickness ratios of the iliac grafts and the first metacarpal bones to calculate the amount of bone resorption. Data from 2 groups reconstructed with or without a terminal tuft were analyzed. Fifteen patients were followed for an average of 20 months (range, 14-72 months). Bone resorption occurred in all 3 measured dimensions in all patients and the degree of resorption increased with time. Resorption amounts of the length dimension in the group with a terminal tuft was significantly decreased compared with those in the group without a terminal tuft at 6 months, 12 months, and the last follow-up. The resorption amount of the width dimension of the distal portion was significantly less in the group with a terminal tuft at the last follow-up. The resorption amount of the thickness dimension of the distal portion was significantly lower in the group with a terminal tuft at 12 months and at the last follow-up. Bone resorption occurred in all dimensions of the graft after thumb reconstruction using a wrap-around flap from the hallux. Flaps including the terminal tuft had less bone resorption in the distal portion. Wrap-around toe flaps should only be used in cases of thumb amputations at the middle of the proximal phalanx and distal, and the terminal tuft should be preserved in the flap; fixation with a plate should be avoided. Therapeutic IV.

Microsurgery Techniques for Patients with Traumatic Thumb Amputation

Introduction. Traumatic amputations of a thumb may happen as a result of severe mechanical injuries with the primary detachment and destruction of tissues, or following deep burns, frostbites or ischemia. In 70 to 80% of cases of disability and the loss of occupational fitness the key causes are traumatic digit and hand amputations. In 50% of cases the loss of ability to work is due to an amputation of a thumb. This makes the issue of thumb reconstruction a priority in surgery of the hand.Materials and methods. This paper presents our experience in the reconstruction of the functional abilities of the hand in 48 patients with traumatic amputations of a thumb. This was performed with the use of reconstructive plastic microsurgery techniques, namely the free transplantation of a second toe onto the hand. All the patients had a thumb stump at the level of the distal part of the metacarpal bone or the proximal part of the proximal phalanx.Results and discussion. A positive outcome was achieved in 45 out of the 48 patients treated. Autograft necrosis occurred in three cases. For these patients the thumb reconstruction was performed with the use of other, less functional methods. The functional condition of the hand manifested an improvement according to the electromyography data obtained at the maximum tonic tension of the thenar eminence muscles, flexor and extensor muscles of the reconstructed digit. In all the cases the hand strength increased by 40 to 90% after the reconstructive surgery; the authors attribute this to the recovery of the key handgrip abilities. According to Doppler ultrasonography data the blood flow velocity and the level of blood filling increased in the hand treated.Conclusion. The reconstruction of functional abilities of the hand with traumatic thumb amputation must be carried out taking into account the available methods of surgical correction and which one of these would be optimal, the evaluation of the patient’s mental status and his or her drive for the fastest possible recovery of the shape and function of the hand. The free autograft of a second toe in place of the lost thumb with microsurgical vascular anastomoses makes it possible to restore most completely the aesthetic and functional abilities of the hand in the shortest possible timeframe.

Long-Term Evaluation of The Functional and Esthetical Outcomes for The New Method of The Toe-To-Hand Transfer for Full-Length Thumb Reconstruction in Congenital Thumb’s Hypoplasia in Children

Abstract Congenital thumb hypoplasia is a rare deformity of the upper extremity. Incidence of thumb hypoplasia type I–V was 2–3 and type IIIb-V was 0.5–1 per 20 000 newborns per year in Latvia. The classification of thumb hypoplasia was created by Blauth in 1967 (type I to V). The base of the metacarpal bone is absent for hypoplasia type IIIb–V; therefore, toe-to hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for successful toe-to-hand transplantation. A technique for toe-to-hand transplantation for thumb hypoplasia type IIIb–V patients has been described in literature but overall results were not better than pollicisation. The aim of this study is to describe a new technique for thumb reconstruction with a second toe transfer with metatarsophalangeal joint arthrodesis, which can provide a 5-digit hand and restore the functionality of the thumb for thumb hypoplasia IIIb–V. Long-term follow up was done to evaluate the functions and aesthetics of the hands. A survey to evaluate aesthetical outcome for the transplantation method and pollicisation method was completed by 290 respondents. The overall population rated the aesthetic outcomes of the new transplantation method significantly higher than for pollicisation (p < 0.0001).

Patient-Reported Outcome Measures for Toe-to-Hand Transfer: A Prospective Longitudinal Study.

Patient-reported outcome measures are an important metric in evaluating treatment efficacy of reconstructive surgery. Toe-to-hand transfer can restore vital prehensile function; however, this surgery is complex, extensive rehabilitation is required, and there are concerns about donor-site morbidity. This study longitudinally explores the benefits of this procedure, from the patient's perspective, using patient-reported outcome measures. Twenty-three patients who underwent free toe-to-hand transfers from 2012 to 2015 were evaluated preoperatively and postoperatively using the following validated questionnaires: the Michigan Hand Outcomes Questionnaire, the 36-Item Short-Form Health Survey, and the Lower Limb Outcomes Questionnaire. Subgroup analysis was performed between dominant and nondominant reconstructed hands. Mechanism of injury was crush in 83 percent; the remainder sustained cutting, avulsion, and burn injuries. Thirty-four toes were transferred: nine great toes, 20 second toes, and five third toes. Michigan Hand Outcomes Questionnaire results showed significant improvement in overall activities of daily living, work, aesthetics, and patient satisfaction (p < 0.05). The results of the 36-Item Short-Form Health Survey showed significant improvements in physical and emotional roles (p < 0.05). The Lower Limb Outcomes Questionnaire showed no deterioration of foot function (p = 0.55). Subgroup analysis showed significant improvement in patient-reported outcome measures for patients undergoing dominant hand reconstruction but no difference between thumb reconstruction and finger-only reconstruction. Patient-reported outcome measures demonstrate the significant utility of toe-to-hand transfer procedures in both functional and psychosocial domains in that there are relatively greater benefits in reconstructing the dominant hand, and that donor-site morbidity is well tolerated. Therapeutic, IV.

Replanting the complex amputated thumb with the pedicled flap from the rasceta area

Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area. Methods From March, 2015 to March, 2017, 12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery. All digital arteries defective with soft tissue defect, the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm. The wound of the wrist donor site was sutured directly. Postoperative followed-up was performed to review if the flap survival. Results There was 1 case of venous reflux disorder. After removal of some sutures, the symptoms were relieved. All other fingers survived successfully, and the flap survived completely. The donor site incision healed at I stage. The followed-up period was 12-18 (average, 13.5) months. The appearance of the thumb and flap was satisfactory, and the scar in the donor site was not obvious. The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery. Eight cases were excellent, 3 cases were good, and 1 case was medium. Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply. It can reconstruct the defect vessels and repair the wound at the same time. It is a new method for replantation of complicated severed thumb. Key words: Wrist transverse flap; Severed finger; Replantation; Microsurgical technique

On-top Plasty for Reconstruction of Thumb Using Index Finger

Thumb is very important for hand function. Many options are available to reconstruct injured thumb from simple dressing (pulp injury without bone exposure) to replantation and toe transfer (significant loss of thumb length). In chronic setting, where other fingers are intact, on-top plasty can be used to reconstruct injured thumb. In this study, a case of a boy who lost his thumb in a road accident is presented. Thumb reconstruction was performed using partially injured ipsilateral index finger. At two months, successful restoration of form and function were noted. Keywords: Index finger on-top plasty; thumb injury; thumb reconstruction.

Application of digital technique to assist in the reconstruction of thumb and fingers defect

Objective To investigate the clinical significance of the reconstruction surgery using the toes to repair thumb and fingers defect with the help of the digital technology. Methods Between June, 2012 and May, 2017, 17 partial thumb and finger defects in 12 cases received 3D-CTA assisted finger reconstruction surgeries in using the toe. Preoperative ipsilateral foot 3D-CTA were conducted and the 3D digital models were analyzed. It helped to know the parameters of the move direction and classification of the arteries and veins, etc. It was helpful for designing personalized surgical scheme that could match with the length of each finger defect and the defect area and shape in the recipient site of the specific case. Results All 17 toe-to-hand transplants in 12 cases survived. With 6-12 month's followed-up, the appearance of the reconstructed fingers was very closed to the normal fingers. The two-point discrimination was 6-10 mm. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 9 digits, good in 6 digits, fair in 1 digit and poor in l digit. Conclusion The digital technology can help to formulate the operation scheme of personalized and accurate reconstruction of thumb and fingers before the operation. It was helpful to reduce the operation risk and improve the survival rate of fingers reconstruction. It has very good practical and clinical significance. Key words: Thumb; Finger; Reconstruction; Digital technology; Computed tomography angiography 3D reconstruction (3D-CTA)

Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation

To investigate the effectiveness of Ilizarov technique in reconstruction of thumb function in patients with thumb degloving injury after amputation. Between June 2011 and September 2016, 9 cases of thumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with an age of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, the level of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (the length of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy finger by 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender was applied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours. After bone lengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with the amputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recovered well; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months. Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with an average of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time of external fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an average of 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healing was finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. No replantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip was similar to that of normal fingertip. The grip strength reached 53%-89% of the healthy side; the kneading force reached 59%-91% of the healthy side. The application of Ilizarov technology to extend the thumb metacarpal lengthening is a good method to reconstruction the thumb function after degloving injury.

Thumb reconstruction with combination of the wrap‐around flap prefabricated by medialis pedis perforator flap with nail bed and phalanx banked from the amputated thumb: A case report

Thumb reconstruction has been a very challenging issue for hand surgeons. In this report, we present a case of thumb reconstruction with combination of the wrap-around flap prefabricated by the medialis pedis perforator flap with phalanx and nail bed banked from the amputated thumb. A 22-year-old man suffered from the left thumb amputation as well as large soft tissue defect of hand and comminuted fracture in wrist due to a crush accident. The distal phalanx and nail bed of left thumb were exposed and no suitable vessels for microsurgical anastomosis could be found, resulting in the great difficulty of replantation. After debridement, nail bed of the amputated thumb was dissected and banked on the medial side of foot, while the distal phalanx was buried in the abdominal subcutaneous tissue. The fracture was fixed with an external fixation and the soft tissue defect was covered with a free anterolateral flap. Wound and bone healing was achieved 6 months after the initial treatment. Thumb was reconstructed with combination of the banked phalanx and a wrap-around flap prefabricated by the medialis pedis perforator flap and the banked nail bed. The postoperative course was uneventful with complications from both reconstruction and donor sites. The nail of the reconstructed thumb grew normally. Thumb oppositional function was rebuilt. The patient was satisfied with the aesthetic and functional outcome at 5-year postoperative follow-up. We propose that tissue banked from the nonreplantable amputated thumb could be used for secondary reconstruction with the technique of flap prefabrication.

Chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing complex tissue defect of the thumb

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb. Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed. There were 7 males and 4 females, aged from 16 to 56 years, with an average age of 31.5 years. The soft tissue defect of the affected finger ranged from 3.0 cm×1.3 cm to 6.3 cm×2.0 cm, and the bone defect ranged from 1.3 cm×0.8 cm×0.4 cm to 2.8 cm×1.3 cm×0.8 cm. All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area. The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue. The flap area ranged from 4.0 cm×1.5 cm to 7.0 cm×3.0 cm and the bone flap size ranged from 1.5 cm×1.0 cm×0.5 cm to 3.0 cm×1.5 cm×1.0 cm. The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association. Results All 11 cases of wrist transverse bone flap survived. The average healing time of the bone flap was 1.6 (range, 1.5-3) months, and the bone graft was not absorbed. The function and appearance of the finger was good with only a linear scar; 6 months after surgery, the two-point discrimination on average was 7.1 mm (range, 5.5-9.0 mm). At the latest follow-up according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association, finger function were excellent in 9 cases, good in 1 case, with the excellent rate of 90.9% (10/11). Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin, soft tissue and bone defects of thumb simultaneously. It has the advantages of simple operation, safe blood supply, speeding up fracture healing, good functional recovery and concealed scar in donor area. It is a new choice to repair the complex tissue defect of thumb. Key words: Finger injuries; Surgical flaps; Microsurgery

Thumb Amputations in Children: Classification and Reconstruction by Microsurgical Toe Transfers

Traumatic amputations of the thumb are rare in children compared with adults, but hand surgeons remain reticent to consider microsurgical reconstruction with toe-to-thumb transfers. This study reports the functional outcomes and complications of children with traumatic thumb amputations who underwent toe-to-thumb reconstruction. A retrospective review of children who sustained thumb amputations and whose parents elected for their child to undergo reconstruction by toe-to-thumb transfer was performed. Details of the level of thumb amputation, whether other fingers were also amputated, which toe was transferred on which vascular pedicle, survival of the transfer, and complications, were collected. Opposition, sensation, and growth of the toe-to-thumb transfers was measured. Functional and psychosocial outcomes were evaluated by both the parents and the older children using the Pediatric Outcomes Data Collection Instrument questionnaire. Twenty-one thumb amputations in 19 children between the ages of 2 and 17 years were referred for secondary reconstruction. Ten were isolated thumb amputations and 11 were combined thumb and multiple finger amputations. Two children had bilateral thumb amputations. Twenty-one toe-to-thumb transfers were performed: 14 second toe transfers and 7 great toe transfers (3 great toe and 2 trimmed and 2 Morrison wraparound variations). There were no immediate postoperative reexplorations of the microsurgical anastomoses and all toe transfers survived completely. All children regained pinch and grasp function and sensation. There were no gait problems in the donor feet. Microsurgical toe-to-thumb transfers should be offered as an alternative option to the traditional techniques of distraction lengthening and pollicization, for posttraumatic thumb reconstruction in children for any level of amputation from just distal to the carpometacarpal joint to the interphalangeal joint. Toe-to-thumb transfer provides length, opposition, and sensation without disturbing ambulation and is associated with excellent psychosocial outcomes as evaluated by both parents and older children. Therapeutic IV.

3D printing technology to assit in the repair of 9 cases of severe damage to the radial side hand

Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand. Methods From March, 2014 to September, 2016, there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand. The donor and recipient areas were scanned by 64 row spiral CT before operation. Three dimensional images were obtained by CTA 3D reconstruction technology. Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system. Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeal bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound. The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm × 5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm × 17.0 cm to 12.0 cm × 25.5 cm, respectively. Postoperative followed-up was performed to evaluate the effect of the operation. Results All 9 thumbs and flaps survived after the operation. Postoperative followed-up time ranged from 8 to 16 months. The appearance of reconstructed thumb was close to normal, and the two-point discrimination was from 8.0 to 11.0 mm. According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences, 7 cases were excellent and 2 cases were good. The survival flaps had soft texture, good blood circulation and satisfactory appearance at the repaired site. Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results. Key words: Destruction of the radial side of the hand; Thumb reconstruction; 3D printing technology; Anterolateral thigh flap; Microsurgical operation

Surgical techniques for reconstruction of the hypoplastic thumb.

The reconstruction of a congenital hypoplastic thumb usually involves release of a tight first web space, metacarpophalangeal joint stabilization, reconstruction of intrinsic muscle function, and extrinsic tendon reconstruction, as appropriate. Numerous surgical options and combinations are available, but the approaches vary among surgeons who work in the field of congenital hand surgery and the empirical evidence that allows for evaluation of the results of techniques is scarce. Both the pre-operative assessment and intra-operative findings of all thumb elements - bone, joints, and soft tissues - should be considered in the surgical decision-making and eventually define the methods of reconstruction. This article summarizes the different reconstructive options.

Surgical Salvage of a Mangled Thumb – A Case Report

Introduction: The reconstruction of mangled extremities is a heavily contentious topic, particularly when the thumb is involved. Thumb reconstruction is attempted at a rate that falls below the recommended guidelines, despite the digit’s significance. This article reviews leading research and concurrent guidelines, alongside a case presentation, in order to offer a distinct perspective on the management of mangled thumbs. Contraindications to Salvage of a Thumb: There are several contraindications to the reattachment to any digits, which can be broadly categorised as follows: * General absolute contraindications -Life-threatening associated injuries -Severe systemic illness * Local absolute contraindications -Extensive contamination -Wrong conservation of amputated part * Relative contraindications -Comorbidities -Advanced age -Psychosis -Avulsion injuries -Multiple-level injuries Clinical Case: A 21-year-old precision lathe operator sustained a mutilating industrial accident to his left thumb, which was heavily contaminated by grease and paint. The patient underwent 10 hours of surgery, and several failed attempts at revascularisation; however, the thumb survived completely. Necrosis of the volar skin had to be debrided and repaired a month after discharge, but the flap healed nicely, and the patient recovered with minimal difficulties and returned to his occupation. Discussion and Conclusion: A tailored, comprehensive biopsychosocial approach is recommended when considering the reattachment of the thumb. In many cases, an attempt to reattach the thumb should be undertaken despite certain contraindications and the severity of the injury, as the benefits of a successful procedure will likely outweigh the potential damage done by a failed operation.

Hallux-nail flap with distal phalanx combined with iliac bone for reconstruction of thumb with III degree defect

Objective To explore the clinical effect of using hallux-nail flap with the distal part of phalanx combined with iliac bone for reconstruction of thumb with III degree defect. Methods From June, 2011 to June, 2016, 7 patients with thumb III degree defect were treated with the hallux-nail flaps with distal phalanx combined with iliac bone to reconstruct thumbs. According to the thumb defect indexing method reported by Cheng Guoliang, the type 1 of thumb III degree defect was 4 cases, and the type 2 of III degree defect was 3 cases. The donor site was covered with skin grafting in 1 case, free superficial iliac artery graft in 5 cases and free peroneal artery perforator flap in 1 case. All patients kept the number and length of donor toes. Regular follow-up was performed after operation to observe the function, shape, feeling of finger reconstruction, the survival condition of flaps or skin graft in donor site, etc. It was also observed if the pain by walking actually exists in the long-term effect. Results All of the reconstructed thumbs survived. One patient suffered the necrotic in the donor site repaired by superficial iliac artery flap, which was successfully covered with the skin graft. All patients were followed-up from 3 months to 18 months (mean, 8 months). The reconstructed thumb with smooth nail had fine textile and good elasticity, good flexion and extension function of the palm, fingers and the metacarpophalangeal joint. The donor sites recovered with fine texture, and there were no difficulties in walking and running and no complaint about the pain and discomfort. According to the Trial Criteria of Upper Limb Functional Evaluation of Chinese Medical Association Hand Surgery Society, 5 cases resulted in excellent, and 2 cases resulted in good. Conclusion The hallux-nail flap with the distal phalanx combined with iliac bone is an excellent option to reconstruct thumb with III degree defect with the outcome of good function and appearance. The trauma of the donor site is small and the number and length of the toes are remained. The clinical effect is good. Key words: Thumb defect; Hallux-nail flap; Reconstruction; Microsurgery

母指示指切断に対する切断示指を用いた母指再建の 1 例

母指示指切断に対する切断示指を用いた母指再建の 1 例

Reconstruction of the Thumb after Traumatic Tissue Loss

The distinctive prehensile functions of the human hand are orchestrated by the thumb. Without a thumb, the hand lacks critical movements allowing for pinch, grasp, and fine manipulation. Based on the patient’s individual needs, occupation, and desires, thumb reconstruction should be offered to every patient with a traumatic amputation. Position, stability, mobility, and sensation command attention when reconstructing the absent thumb. We present the spectrum of various techniques available for reconstructing a useful thumb. This review contains 9 figures, 3 tables and 51 references. Key words: Thumb; reconstruction, amputation, pollicization, toe transfer, metacarpal lengthening, webspace deepening

The first dorsal metacarpal artery flap: A practical operation for thumb reconstruction

Objective: To present six cases treated with kite flap for thumb reconstruction and to discuss important aspects of the first dorsal metacarpal artery (FDMA) flap technique along with the pertinent literature. Method: We evaluated the age, etiology, operation time, and postoperative flap necrosis of six patients who had undergone thumb reconstruction with FDMA flap between 2014 and 2017. All patients signed a written informed consent form. A) Relevant anatomy: The FDMA is a branch of the radial artery. It supplies the dorsal aspect of the index finger up to the proximal interphalangeal (PIP) joint. The artery is located in the groove between radial of the body of the second metacarpal bone and the ulnar head of the first interosseous muscle. B) Flap design and surgical technique: The proximal and distal borders of the flap were constituted from the metacarpophalangeal (MCP) and PIP joints, respectively. Flap elevation was performed from the distal to proximal direction and from the ulnar to radial side. Results: The average patient age was 46.8 years. Five patients underwent surgery due to trauma and one patient underwent surgery due to a painful scar on the tip of the thumb. For the five trauma patients, thea verage operation time was 1.4 days. The patient with the painful scar had sustained the trauma 15 years ago. Flap necrosis was not observed. The average postoperative follow-up duration was 1.6 years. Conclusion: The FDMA flap is a safe and practical solution for thumb reconstruction provided that the anatomy of the FDMA is well known and proper technique is used.