Thumb reconstruction by the wrap-around method.
Reconstruction of a thumb amputated distal to the metacarpophalangeal joint can be accomplished by the "wrap-around" procedure. The operative procedure calls for an iliac crest graft to replace the bone of the amputated thumb. A flap from the great toe with innervation and circulation intact, including the toenail as well as sensory nerve, is wrapped around an iliac crest graft in a single-stage reconstruction of the thumb. This procedure allows a nice aesthetic result; the nail is transferred, sensibility is restored to the amputated thumb through the transferred neurovascularly intact flap, and the procedure is done at a single sitting. Results to date have been excellent in ten patients.
D000673:Amputation, Traumatic / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D009262:Nails / Q000637:transplantation; D016038:Skin Transplantation; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps; D013933:Thumb / Q000293:injuries* / Q000601:surgery; D014034:Toes / Q000601:surgery