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Comprehensive Thumb/Finger Reconstruction by Composite Tissue Transfers from Different Parts of the Body: Report of 719 Thumbs/Fingers in 636 Patients
Zeng Tao Wang, MD
Department of Hand and Foot Surgery, Shandong Provincial Hospital, Jinan, Shandong, China

Hypothesis: Instead of simple toe to hand transfer, comprehensive thumb/finger reconstruction by combining several different composite tissues from the body, including the foot, will achieve better results, and less donor site morbidity.

Methods: We started anatomical and clinical studies to reconstruct a thumb/finger by using composite tissues from the foot and the other parts of the body in 1999. Therefore, a thumb/finger can be “built” with materials from different parts of the body, instead of simple moving a toe to the hand. The reconstructed skin and nail were from the big toe wrap round flap. Iliac bone graft was commonly used for phalangeal bone reconstruction, whereas toe IPJs were used for joint reconstruction. From September 1999 to September 2010, we reconstructed 719 thumbs/fingers in 636 patients with this new technique other than simple toe to hand transfer. We present the results of I-IV degree defect thumb/finger reconstruction here.

Results: All reconstructed thumbs/fingers were successful. The number of reconstructed thumb/finger in a patient ranged from 1 to 4. All donor feet had at least 4 toes preserved. 91 patients still had 10 toes on both feet. Therefore, the donor site morbidity, especially on the foot, was significantly decreased. The reconstructed thumb/finger resemble closely to the contralateral side in nail size, length and diameter of the digit, skin texture, joint position etc. Most importantly, PIPJs could gain more than 100° flexion and almost full extension. All reconstructed digits had good sensation.

Summary Points: Compared to traditional simple toe to hand transfer, our comprehensive thumb/finger reconstruction by combining different composite tissues from the body has the following advantages:

  1. Better esthetic and functional results;
  2. Less donor site morbidity, especially on the foot.
However, the procedure is more complicated. Delicate microsurgical technique and meticulous operative design are needed.
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