Microsurgical thumb repair and reconstruction

2017 ◽  
Vol 42 (8) ◽  
pp. 771-788 ◽  
Author(s):  
Roberto Adani ◽  
Sang Hyun Woo
Keyword(s):  
Thumb Reconstruction ◽  
Great Freedom ◽  
Thumb Amputation ◽  
Suitable Technique ◽  
Reconstructive Techniques ◽  
Second Toe ◽  
Different Levels ◽  
Surgical Choices

In this article, we review microsurgical reconstructive techniques available to treat thumb amputation at different levels based on our experience. We reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumb reconstruction are summarized. Different microsurgical transfer techniques suggest a great freedom of surgical choices. However, the choices are considerably restricted if all functional and cosmetic requirements are to be met. We recommend individualized surgical design and reconstruction because each case of thumb amputation is unique.

scholarly journals Microsurgery Techniques for Patients with Traumatic Thumb Amputation

2019 ◽  
Vol 9 (1) ◽  
pp. 44-49
Author(s):  
M. M. Valeev ◽  
I. Z. Garapov ◽  
E. M. Biktasheva
Keyword(s):  
Proximal Phalanx ◽  
Proximal Part ◽  
Functional Condition ◽  
Positive Outcome ◽  
Thenar Eminence ◽  
Metacarpal Bone ◽  
Functional Abilities ◽  
Thumb Reconstruction ◽  
Thumb Amputation ◽  
Second Toe

Introduction. Traumatic amputations of a thumb may happen as a result of severe mechanical injuries with the primary detachment and destruction of tissues, or following deep burns, frostbites or ischemia. In 70 to 80% of cases of disability and the loss of occupational fitness the key causes are traumatic digit and hand amputations. In 50% of cases the loss of ability to work is due to an amputation of a thumb. This makes the issue of thumb reconstruction a priority in surgery of the hand.Materials and methods. This paper presents our experience in the reconstruction of the functional abilities of the hand in 48 patients with traumatic amputations of a thumb. This was performed with the use of reconstructive plastic microsurgery techniques, namely the free transplantation of a second toe onto the hand. All the patients had a thumb stump at the level of the distal part of the metacarpal bone or the proximal part of the proximal phalanx.Results and discussion. A positive outcome was achieved in 45 out of the 48 patients treated. Autograft necrosis occurred in three cases. For these patients the thumb reconstruction was performed with the use of other, less functional methods. The functional condition of the hand manifested an improvement according to the electromyography data obtained at the maximum tonic tension of the thenar eminence muscles, flexor and extensor muscles of the reconstructed digit. In all the cases the hand strength increased by 40 to 90% after the reconstructive surgery; the authors attribute this to the recovery of the key handgrip abilities. According to Doppler ultrasonography data the blood flow velocity and the level of blood filling increased in the hand treated.Conclusion. The reconstruction of functional abilities of the hand with traumatic thumb amputation must be carried out taking into account the available methods of surgical correction and which one of these would be optimal, the evaluation of the patient’s mental status and his or her drive for the fastest possible recovery of the shape and function of the hand. The free autograft of a second toe in place of the lost thumb with microsurgical vascular anastomoses makes it possible to restore most completely the aesthetic and functional abilities of the hand in the shortest possible timeframe.

Combined Pollicization and Toe Transfer for Thumb Reconstruction

2003 ◽  
Vol 28 (5) ◽  
pp. 414-416 ◽  
Author(s):  
H. U. STEINAU ◽  
M. LEHNHARDT ◽  
H. H. HOMANN
Keyword(s):  
Index Finger ◽  
Orthopaedic Surgeon ◽  
Thumb Reconstruction ◽  
Severe Injuries ◽  
Lawn Mower ◽  
Thumb Amputation ◽  
Toe Transfer ◽  
Second Toe

A 45-year-old orthopaedic surgeon sustained a complete thumb amputation and severe injuries to his index finger in a lawn mower accident. He was treated with a combined second toe transfer and an index finger pollicization.

scholarly journals Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Distal Interphalangeal Joint ◽  
Thumb Reconstruction ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe ◽  
Different Levels

Abstract Background Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction. Methods We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). Results One patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option. Conclusions Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

Thumb Reconstruction using Second—Toe Transfer

HAND ◽  
1983 ◽  
Vol os-15 (1) ◽  
pp. 15-21 ◽  
Author(s):  
P. C. Leung
Keyword(s):  
Thumb Reconstruction ◽  
Toe Transfer ◽  
Second Toe

scholarly journals Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

2012 ◽  
Vol 45 (01) ◽  
pp. 154-157 ◽  
Author(s):  
Rajendra Nehete ◽  
Anita Nehete ◽  
Sandeep Singla ◽  
Harshad Adhav
Keyword(s):  
Functional Impairment ◽  
Thumb Amputation ◽  
Aesthetic Results ◽  
Post Traumatic ◽  
Technical Details ◽  
Toe Transfer ◽  
Second Toe

ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

scholarly journals Cosmetic and Functional Results of a Newly Reconstructed Thumb by Combining the Phalange of Second Toe and the Great Toenail Flap Transplantation

2020 ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Aesthetic Result ◽  
Aesthetic Results ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe

Abstract BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalange transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). RESULTS 1 patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and aesthetic results of both the donor and the recipient sites were satisfactory.CONCLUSIONS Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and 2nd toe phalange achieved a substantially better functional and aesthetic result in the thumb reconstruction.

Thumb Reconstruction after Amputation at the Interphalangeal Joint by Gradual Lengthening of the Proximal Phalanx

HAND ◽  
1979 ◽  
Vol os-11 (3) ◽  
pp. 302-305 ◽  
Author(s):  
Ivan B. Matev
Keyword(s):  
Proximal Phalanx ◽  
Interphalangeal Joint ◽  
Thumb Reconstruction ◽  
Thumb Amputation ◽  
Amputation Stump ◽  
Original Length ◽  
Cent Increase

A case of thumb amputation at the interphalangeal joint and reconstruction by gradual lengthening of the proximal phalanx is described. As a result of the treatment the amputation stump was lengthened 2cms which means a 70 per cent increase of the original length of the proximal phalanx. The quality of sensibility of the stump has been preserved.

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