Thumb reconstruction with partial toe transfer *
Twenty seven transfers of the great and second toe have been performed for the partial or total reconstruction of deficits of the thumb. The great toe transfers consisted of one vascularized whole nail graft and onychocutaneous flaps including the nail and a skin flap from the toetip, three trimmed great toetips, six thin osteo-onychocutaneous flaps, three wrap-around flaps, three using a combined wrap-around flap and dorsalis pedis flap, three using a combined a wrap-around flap and one using a second toe MP joint transfer, and a combined wrap-around flap and a first web-space flap. Second toe transfers consisted of two combined second toes and a dorsal pedis flap. The other transfers consisted of two that combined a thoracodorsal artery perforator flap and vascularized scapula. For nail reconstruction of the thumb, onychocutaneous flaps with sensory potential from the big toe were most suitable. Loss of the distal phalanx of the thumb can be repaired with a thin osteo-onychocutaneous flap from the big toe. With the thin osteo-onycocutaneous flap, there is minimal damage to the donor toe. Claw nail deformities of the thumb can be repaired with a trimmed great toetip including the distal phalangeal bone and a sterile nail matrix. For thumb loss at the level of the proximal phalanx, wrap-around flaps with a free iliac bone graft are very useful and achieve a good cosmetic results. Use of vascularized iliac bone grafts is recommended in the case of defecits at the metacarpal joint to prevent absorption of the grafted bone. For a total thumb deficit at the level of the CM joint including thenar skin loss, the combined second toe and dorsalis pedis flap was most suitable. (Accepted on October 25, 2000) Kawasaki Igakkaishi 27(1) : 49 - 58, 2001
