title: Donor foot morbidity following modified wraparound flap for thumb reconstruction: a follow-up of 69 cases.
abstract: OBJECTIVE
  To evaluate donor foot morbidity after thumb reconstruction using a modified wraparound flap.
  
  
  METHODS
  We observed patients who accepted thumb reconstruction with the modified wraparound flap between January 2001 and December 2009. We examined and evaluated the reconstructed thumb and donor foot. Donor morbidity was assessed on both a subjective and an objective basis using the Foot Function Index-verbal rating scales (FFI-5pt), the American Orthopaedic Foot and Ankle Society for Hallux Metatarsophalangeal-Interphalangeal (MTP-IP) scale, and gait analysis and dynamic pedodynographic measurements.
  
  
  RESULTS
  We reviewed 69 patients; the follow-up period ranged from 6 months to 5 years, with an average of 26 months. The reconstructed thumbs had good aesthetic appearance, and static 2-point discrimination averaged 9.4 ± 2.7 mm. Full length or most of the length of the donor toes was preserved in 67 patients. The retained plantar strip was significantly enlarged from an average of 14.5 ± 1.4 mm measured at surgery to 27.8 ± 4.7 mm measured at last follow-up (p < .05), and its 2-point discrimination was 9.1 ± 2.3 mm. A total of 34 patients were available for FFI-5pt and Hallux MTP-IP scale evaluation. The FFI-5pt total score was 3.1 ± 2.7 and the total Hallux MTP-IP score was 87.9 ± 7.1. Gait analysis and dynamic pedodynographic measurements were available in 20 patients. All 5 biomechanical parameters (timing, trajectory, symmetry, average peak force, and peak pressure between donor foot and the contralateral foot) had no significant difference.
  
  
  CONCLUSIONS
  The function of the donor foot after a modified wraparound flap for thumb reconstruction was well preserved, the degree of pain and disability in the donor foot was mild, and foot function in gait was not disturbed. Although a certain degree of restriction in interphalangeal joint motion occurred, this was nearly negligible and did not deter return to normal daily living activity, work, and recreation.
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China. panyongwei@yahoo.com.cn
authors.forename: Yong-wei
authors.initials: YW
authors.lastname: Pan
authors.forename: Lishan
authors.initials: L
authors.lastname: Zhang
authors.forename: Wen
authors.initials: W
authors.lastname: Tian
authors.forename: Guanglei
authors.initials: G
authors.lastname: Tian
authors.forename: Junhui
authors.initials: J
authors.lastname: Zhao
authors.forename: Xianfeng
authors.initials: X
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005684:Gait / Q000502:physiology; D006214:Hallux; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects*; D013933:Thumb / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult