Thumb reconstruction with a wrap-around free flap according to the level of amputation

Abstract

In 1980, Morrison and O'Brien reported their experiences with the reconstruction of an amputated thumb using a wrap-around neurovascular free flap from the great toe, but its indication has been limited distal to the metacarpophalangeal (MP) joint (Morrison et al., J Hand Surg 5:575-583, 1980). We have performed 37 wrap-around free flaps from the great toe for the reconstruction of thumbs amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. The amputation was distal and proximal to the MP joint in 25 and 12 cases, respectively. Pinching and grasping power, two-point discrimination, and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the results of two-point discrimination was better in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In the 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of 30 degrees flexion and 45 degrees internal rotation. However, in the other six cases in the fixation of 30 degrees flexion and 30 degrees internal rotation, the opposition of the reconstructed thumb to the ring and little fingers was impossible in five cases and only to the little finger in one case. In this study, we concluded that amputation proximal to the MP joint is not an absolute contraindication to the wrap-around free flap procedure for thumb reconstruction. However, for a better functional outcome, we recommend iliac bone block fixation in the position of 30 degrees flexion and 45 degrees internal rotation.

Factors Affecting Hand Function Following Reconstructive Thumb Operation (RTO): A Report of Eight Cases

“…This might be because interphalangeal joints were fixed in WAFM. On the other hand, both grip strength and pinch strength ranged from 65 to 75%, which was similar to the results of Blomgran et al (1988) and Lee (1995Lee ( , 2000. A small number of patients showed "not more than 6 mm" in static 2PD, which indicated the unfavorable result.…”

Combined Pollicization and Toe Transfer for Thumb Reconstruction

“…Combination procedures such as pollicization and wrap-around flaps have been reported for thumb reconstruction in the past (Barbato et al, 1998). However, wrap-around techniques were found to have a considerable rate of complication and they do not restore pinch sensation (Lee et al, 2000;Steichen, 1991). In order to achieve optimal motor and sensory function after thumb reconstruction, we believe that the THUMB RECONSTRUCTION combination of a toe transfer and a partial pollicization represents a feasible alternative to previously described standard techniques (Fig 5).…”

Combined two foot flaps with iliac bone graft for reconstruction of the thumb

“…On the basis of Lee’s technique (Lee et al., 2000), the grafted iliac bone was fixed parallel to the longitudinal axis of the proximal phalanx of the thumb in our study, thus the thumb amputation was changed to a thumb degloving injury.…”

“…Lee et al. (2000) reported on 25 cases of thumb amputation distal to the MP joint reconstructed with a wrap-around free flap from the great toe and a grafted iliac bone.…”

“…No sacrifice of the other digit or the great toe is needed and little discomfort is reported while walking. Lee et al (2000) reported that they performed reconstruction of the amputated thumb using the wrap-around free flap from the great toe. Satisfactory functional and cosmetic results have been achieved.…”