Single-stage reconstruction of the subtotally amputated thumb: a synchronous neurovascular flap and Z-plasty.
A method is described for the management of thumb amputation at the level of the interphalangeal (IP) joint when the thumb is unsuitable for replantation. This method provides healthy stump coverage with an innervated volar thumb rotation advancement flap, preserving unviolated the critical ulnar dorsal area of the stump. THe deep Z-plasty facilitates the movement of the thumb flap and allows direct closure of the secondary defect. The simultaneous deepening of the web space effectively lengthens the thumb. The method has been used in four patients for whom replantation was not suitable. The flaps have proved safe, reliable, and mobile. Reconstruction is completed in one stage.
D000673:Amputation, Traumatic / Q000601:surgery*; D005384:Finger Joint / Q000503:physiopathology; D005385:Fingers / Q000098:blood supply / Q000294:innervation; D005500:Follow-Up Studies; D006801:Humans; D008866:Microsurgery / Q000379:methods; D012867:Skin / Q000098:blood supply / Q000294:innervation; D016038:Skin Transplantation; D013524:Surgical Flaps; D013933:Thumb / Q000601:surgery*