Microsurgical Reconstruction of the Thumb

Woo, Sang Hyun

Abstract

Compared with non-microsurgical reconstruction of the thumb, microsurgical reconstruction can provide more desirable postoperative results regarding to the function as well as appearance. Toe transfer in one of its forms offers many of the best ways to reconstruct defects of the thumb. For reconstruction of the pulp, nail, and the first web space, microsurgical transfer of required tissues provides excellent sensory restoration leaving little morbidity at the foot. For composite defect of the partial thumb amputations, wrap-around procedure and trimmed great toe transfer is one of the best options in cosmesis. Trimmed great toe transfer technique is to circumvent the lack of motion of the wrap-around flap. In cases of loss of the entire thumb, preliminary procedure is inevitable to avoid foot morbidity. After distant groin flap and autogenous bone graft, secondary toe-to-hand transfer is possible with great toe or second toe. Regarding to operation timing, preoperative planning is very important to induce rapport formation between patient and doctor. In case of malignant tumor resection, immediate reconstruction is much better than delayed reconstruction. Transfer of all parts of the great toe imparts some morbidity to the foot, but the effect when evaluated with gait studies is generally minimal. Certainly, the tradeoff of a thumb for the loss of the great toe is usually well-accepted by the patient. The primary disadvantage of these techniques is their inherent complexity and, although they offer superb reconstructive options in patients with loss of all or part of the thumb, their application should probably be limited to those practitioners with experience.