Open Wound Reconstruction of the Thumb Tip: A Review of Current Literature and Case Reports

Abstract

The thumb is regarded as the most important digit of the hand, accounting for approximately 40% of the entire function of the hand, loss of a functional thumb leads to loss of key functions and patient autonomy. When the nature of the injury and the amputated part allow it, replantation is the standard of care. However, in cases of tip injury, where the amputated tissue is destroyed or otherwise rendered unusable, other reconstructive methods are used. It is imperative to maintain as much function and sensation as possible while restoring as much lost function and sensation as possible. This includes preservation of the interphalangeal (IP) joint, achieving good soft tissue coverage and restoring motor and sensory functions. With a variety of techniques described in the literature, thumb reconstruction proves to be a formidable task. Moreover, the technique selected must minimized complications associated with reconstruction such as hypersensitivity, contracture deformities, poor aesthetics, limited range of motion and insufficient coverage. We review and summarize the techniques of revision amputation, Moberg advancement flap, FDMA flaps, free tissue transfer from the great toe and non-operative management. We include case reports that highlight the benefits and limitations of some of these techniques.