Distal Thumb Reconstruction Using a Mini Wrap-Around Flap from the Great Toe

Abstract

We have used a great toe mini wrap-around flap for reconstruction of the thumb at, or distal to, the interphalangeal joint. Our series included 12 patients with traumatic amputations. A flap including the entire nail and most of the distal phalanx of the great toe was used. Eleven of the grafts survived. Sensibility was good with an average of 10 mm static two-point discrimination (range, 5-15) and there were no complaints of cold intolerance. All patients were pleased with the appearance of the thumb and there was no significant morbidity at the great toe donor site. The great toe mini wrap-around flap is an excellent reconstruction technique for selected patients with distal thumb amputations.

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.…”

Neurokutaner Insellappen nach Foucher

“…In den späten 70er-Jahren wurden dann die freien Lappenplastiken von den Zehen [2,4,8,29,30] als eine weitere Möglich-keit zur sensiblen Defektdeckung am Daumen beschrieben. Die erreichbare sensible Qualität für die statische 2-PD wird mit 8-15 mm angegeben [1,8,30].…”

“…Die hierdurch entstehenden Probleme werden in der Literatur jedoch kaum beschrieben. Die freien Lappenplastiken bergen im Vergleich zu den gestielten Lappenplastiken die erhöhte Gefahr des Teil-oder Totalverlustes [2]. Störende Narben [30] und Probleme beim Laufen [20] sind die Hauptbeschwerden im Bereich der Hebestellen an der unteren Extremität.…”

“…Zehe und den Zehenzwischenräu-men beschrieben [2,4,8,29,30]. Diese freien Lappen benötigen neben der mikrochirurgischen Anastomose der Gefäße auch eine Koaptation der Nerven im Empfänger-gebiet.…”

Painful foot neuromas after toe-to-thumb transfer

“…For example, 3 of 12 patients were reported to have mild pain after wraparound procedures for thumb reconstruction but a specific cause for this pain such as a neuroma was not given. 4 Although Foucher et al 5 reported no foot complications after second-toe transfers in children at least 1 other group 6 has reported pain: 5 of 11 children had pain in the new intermetatarsal space between the hallux and the third toe and 7 had overt or early hallux valgus. Balance maintenance and rate of displacement of the center of pressure when standing on 1 foot with eyes closed were altered for limbs that had surgery compared with those that did not.…”