Thumb reconstruction by micro-vascular techniques.
Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and manual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm two point discrimination, 59% of strength in pinching (compared to normal side), 30 degrees of range of flexion but with a flessum deformity (average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale). Partial toe transfers were useful in amputations at metacarpophalangeal (MP) level and distal to this area. Around MP level, three techniques were available: wrap around, Twisted Two Toes and "bipolar" lengthening. More distally a "custom made" transfer allows to match exactly the defect. All of these techniques save the great toe length. When a pulp was incorporated in the transfer, two point discrimination averaged 9 mm and in the entire series the mean pinch strength was 93% normal and the mean cosmetic score was 3.5 points. Partial toe transfers are preferable in cases with any otherwise normal hand, providing good function and better cosmesis.
Foucher
G
G
SOS Main, Strasbourg, France.
Binhamer
P
P
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D013933:Thumb / Q000098:blood supply / Q000293:injuries*; D014034:Toes / Q000637:transplantation*; D016896:Treatment Outcome