Combined Osteodistraction and Free “Mini Wraparound” Great Toe Flap for Thumb Reconstruction After Amputation at the Metacarpophalangeal Level

Abstract

Amputation at metacarpophalangeal joint can be treated employing different techniques including pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, and distraction lengthening. Choosing the optimal technique depends on the level of amputation and the patient’s age, sex, occupation, and functional demands. The reconstruction of a traumatically amputated thumb requires matching the individual needs of the patient to one or more of the possible treatment options available to the surgeon.

This case illustrates a combination of two surgical procedures, metacarpal lengthening and mini wraparound flap from the great toe, to improve the donor site appearance while maintaining the same aesthetic results for the thumb.

There were no complications or postoperative vascular compromise. The mean pinch power was 66% of the contralateral hand. The static two-point discrimination of the reconstructed thumb was 8 mm. The patient reported being satisfied with the treatment, and the donor site morbidity was minimal.

The case shows that thumb reconstruction using metacarpal lengthening plus mini wraparound flap from the great toe can be performed successfully. The treatment process is lengthy; however, the patient felt that the time invested was well spent. This technique has been best accepted by young, well-motivated patients.