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Modified Wrap-Around Flap for Thumb Reconstruction in 73 Cases: Techniques and Follow-Up Results
Yongwei Pan, MD
Departmet of Orthopaedic Surgery, Tsinghua Hospital, Tsinghua University, Beijing, China

Purpose: To introduce a modified technique for thumb reconstruction and follow-up results of the function of reconstructed thumb and donor foot mobidity.

Methods: The toe flap includes the entire nail, two-thirds of lateral and one-third of medial skin but preserves a plantar strip extending around the toe tip. This residual toe skin covers the weight bearing area of the donor toe and retains its sensory supply by preservation of the medial digital nerve. As to the preparation of the thumb stump for receiving the free flap and the bone graft, a volarly based triangular flap is fashioned from the amputation stump tip, and the skeletal remnant is prepared to take a bone graft. When the wrap-around flap is transferred, the flap is wrapped around the bone graft and the volarly based triangular flap fashioned from the amputation stump tip is inset into the volar wound to further decrease the tension at the base of the reconstructed thumb. Soft tissue defects of the donor great toe were covered with split-thickness skin grafts. Patients who accepted thumb reconstruction with this modified technique were followed up. The reconstructed thumb and donor foot were examined and evaluated.

Results: Seventy-three patients were reviewed, and the follow-up period ranged from 6 months to 5 years, averaging 26 months. The reconstructed thumbs had very good aesthetic appearance, and static two-point discrimination averaged 9.4 ± 2.7 mm . Full or most of the length of the donor toes was preserved in 71 patients. The retained plantar strip significantly enlarged from an average of 14.5 ± 1.4 mm measured at operation to 27.8± 4.7mm measured at last follow-up, and its two-point discrimination was 9.1 ± 2.3 mm . Thirty-four patients were available for FFI -5pt and Hallux MTP-IP scale evaluation, and 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 of four biomechanical parameters (timing, trajectory, symmetry and integral between donor foot and the opposite normal foot had no significant difference.

Conclusions: Reconstruction of the thumb with the modified wrap-around flap from the big toe is a recommended method for its excellent functional and cosmetic results both on the reconstructed thumb and donor toe. Full functional potential of the donor toe was retained.

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