Reconstruction of the thumb interphalangeal joint from the second toe proximal interphalangeal joint combined with artificial dermis covering

Abstract

Rationale: Thumb function is one of the most fundamental components of hand function, and a vast majority of hand functions are derived from thumb motion. Injury of the thumb interphalangeal joint has a tremendous impact on the function of the thumb, and damage to the thumb interphalangeal joint (IPJ) caused by trauma is usually accompanied by dislocation of the surrounding skin; therefore, it is particularly important to restore the thumb anatomy and skin coverage. Patient concerns: A 41-year-old woman presented with IPJ disfigurement accompanied by a local skin defect caused by machine compression of her right thumb. Restoring the appearance and function of the thumb is key to this operation. Diagnoses: Open fracture of the right thumb. Interventions: After detailed preoperative and radiographic evaluation, the appearance and function of the thumb were reconstructed by IPJ grafting and artificial dermis covering. Outcomes: At 4 months’ follow-up, the patient's visual analogue score was 0, no complications (eg, osteomyelitis, osteolysis, osteoarthritis, and nonunion of the artificial dermis) were observed, and the range of motion of the thumb IPJ returned to 60% of that of the healthy side. Lessons: The innovative application of the second toe proximal IPJ flap combined with double-layer artificial dermis covering to reconstruct the thumb IPJ defect not only solves the problem of skin defects in the recipient area after transplantation in previous cases but also restores the beauty of the recipient area, making it easier for patients to accept this surgical program.