Thumb reconstruction with a free neurovascular wrap‐around flap from the big toe: Long‐term follow‐up of thirty cases

Abstract

From March 1982 to December 1992, 30 cases of thumb reconstruction with a free neurovascular wrap-around flap from the big toe were performed at Korea University Hospital. Twenty-nine of a total of 30 cases were successful and obtained excellent functional and cosmetic results. Postoperative complications included 1 case of graft failure, 6 partial skin necroses, 1 malunion, and 15 cases of resorption of iliac bone graft including 1 case of fatigue fracture of grafted bone. Even for the first metacarpal neck amputations, thumb reconstruction with a free neurovascular wrap-around flap was possible; however, limitation of motion of the reconstructed thumb and resorption of the grafted bone occurred. Thumb reconstruction with a wrap-around free flap from the big toe gives excellent cosmetic and functional results and causes minimal morbidity on the donor site.

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

“…Moving two-point discrimination (m2PD) and distinction between a sharp and dull touch both had positive and significant correlations with the modified Tamai ADL questionnaire and the Tamai score as well as subjective symptoms. Lee et al (1995) noted that patients ( n = 9) with three nerves reconstructed had better sensation than a patient with only one nerve reconstructed (s2PD 8.2 and 15 mm, respectively). According to our results, the number of nerve reconnections did not have a statistically significant influence on the achieved sensation for each transfer, measured with Semmes–Weinstein filaments, s2PD or m2PD.…”

A Systematic Review of Outcomes of Toe-to-Thumb Transfers for Isolated Traumatic Thumb Amputation

“…Other studies were rejected because they did not mention the level of the amputated thumb [2]. Five studies were rejected because of duplication of data from prior publications [1,5,23,25,52]. There were variations in the quality and quantity of data presented in the 25 studies that were included in this review.…”

Composite Osteocutaneous Groin Flap Combined with Neurovascular Island Flap for Thumb Reconstruction

“…Reconstruction of an amputated thumb using a nonvascularized bone block graft harvested from the iliac crest, which is covered with a free flap taken from the big toe is a common procedure (Doi et al, 1985;Lee et al, 2000;Morrison et al, 1980). However, as the bone graft has no blood supply, resorption, infection and nonunion of the graft frequently occur, resulting in an unstable thumb pulp tip and nail (Doi et al, 1985;Lee et al, 1995;Nunley et al, 1985). The graft can also fracture because of the resorption.…”