The Thumb pp 287-303 | Cite as

Soft Tissue Reconstruction

  • Seong Eon Kim
  • Hyun Tae Lee


For the proper thumb function, the thumb should have appropriate length with pliable and sensate soft tissue. The external appearance of the thumb is also important due to its noticeable position. Thumb defect is classified into four groups by Lister: (1) acceptable length but poor soft tissue coverage, (2) subtotal amputation with uncertainty in length, (3) total amputation with basal joint, and (4) total amputation without basal joint. This chapter will discuss about reconstruction options of soft tissue defects of the thumb within the Group I defect. Soft tissue defects on the thumb can be caused by machinery compression, burn, knife injury, and inflammation. The goals of soft tissue reconstruction of the thumb include length, sensory, and appearance. Various options such as local flaps, distant flaps, and free flaps are available. The location and size of the defect are key determinants for the choice of the flap. Other considerable factors are patient age, hand dominance, occupation, and surgeon’s familiarity.


Thumb Reconstruction Flap 


  1. 1.
    Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg. 2014;41(3):325–59.CrossRefGoogle Scholar
  2. 2.
    Lister G. The choice of procedure following thumb amputation. Clin Orthop Relat Res. 1985;195:45–51.Google Scholar
  3. 3.
    Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg. 1964;46A:817–25.CrossRefGoogle Scholar
  4. 4.
    Germann G, Sauerbier M, Rudolf KD, Hrabowski M. Management of thumb tip injuries. J Hand Surg Am. 2015;40(3):614–22.CrossRefGoogle Scholar
  5. 5.
    Germann G, Rudolf KD, Levin SL, Hrabowski M. Fingertip and thumb tip wounds: changing algorithms for sensation. aesthetics, and function. J Hand Surg Am. 2017;42(4):274–85.CrossRefGoogle Scholar
  6. 6.
    Pederson WC. Nonmicrosurgical coverage of the upper extremity. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Operative hand surgery. 6th ed. Philadelphia: Churchill Livingstone; 2011. p. 1645–720.CrossRefGoogle Scholar
  7. 7.
    Foucher G, Delaere O, Citron N, Molderez A. Long-term outcome of neurovascular palmar advancement flaps for distal thumb injuries. Br J Plast Surg. 1999;52(1):64–8.CrossRefGoogle Scholar
  8. 8.
    Moschella F, Cordova A, Pirrello R, Brunelli F. Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Surg Radiol Anat. 1996;18(3):179–81.CrossRefGoogle Scholar
  9. 9.
    Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg. 2006;117(3):920–6.CrossRefGoogle Scholar
  10. 10.
    Bao QY, Xiao CW, Peng F, Han D, Wang T, Gu YD. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. Reconstr Microsurg. 2014;30(1):15–20.CrossRefGoogle Scholar
  11. 11.
    Brunelli F, Vigasio A, Valenti P, Brunelli GR. Arterial anatomy and clinical application of the dorsoulnar flap of the thumb. J Hand Surg Am. 1999;24(4):803–11.CrossRefGoogle Scholar
  12. 12.
    Hrabowski M, Kloeters O, Germann G. Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg Am. 2010;35(4):659–62.CrossRefGoogle Scholar
  13. 13.
    Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann Plast Surg. 2008;61(4):385–91.CrossRefGoogle Scholar
  14. 14.
    Wilkinson TS. Reconstruction of the thumb by radial nerve innervated cross-finger flap. South Med J. 1972;65(8):992–4.CrossRefGoogle Scholar
  15. 15.
    Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg. 1983;72(5):688–97.CrossRefGoogle Scholar
  16. 16.
    Peacock E. Reconstruction of the thumb. In: Flynn JE, editor. Hand surgery. Baltimore: Williams & Wilkins; 1966.Google Scholar
  17. 17.
    Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am. 1990;15:148–54.CrossRefGoogle Scholar
  18. 18.
    Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63(3):344–9.CrossRefGoogle Scholar
  19. 19.
    Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg. 2004;53(5):449–54.CrossRefGoogle Scholar
  20. 20.
    Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009;4(1):27–33.CrossRefGoogle Scholar
  21. 21.
    El-Khatib HA. Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surg Am. 1998;23(4):647–52.CrossRefGoogle Scholar
  22. 22.
    Foucher G, Merle M, Maneaud M, Michon J. Microvascular free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg. 1980;65(5):616–27.CrossRefGoogle Scholar
  23. 23.
    Buncke HJ, Rose EH. Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg. 1979;63(5):607–12.CrossRefGoogle Scholar
  24. 24.
    El-Gammal TA, Wei FC. Microvascular reconstruction of the distal digits by partial toe transfer. Clin Plast Surg. 1997;24(1):49–55.PubMedGoogle Scholar
  25. 25.
    Dautel G, Corcella D, Merle M. Reconstruction of fingertip amputations by partial composite toe transfer with short vascular pedicle. J Hand Surg. 1998;23B(4):457–64.CrossRefGoogle Scholar
  26. 26.
    Kamei K, Ide Y, Kimura T. A new free thenar flap. Plast Reconstr Surg. 1993;92(7):1380–4.PubMedGoogle Scholar
  27. 27.
    Yang JW, Kim JS, Lee DC, Ki SH, Roh SY, Abdullah S, Tien HY. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg. 2010;26(8):529–38.CrossRefGoogle Scholar
  28. 28.
    Lee SH, Cheon SJ, Kim YJ. Clinical application of a free radial artery superficial palmar branch flap for soft-tissue reconstruction of digital injuries. J Hand Surg. 2017;42E(2):151–6.CrossRefGoogle Scholar
  29. 29.
    Omokawa S, Ryu J, Tang JB, Han J. Vascular and neural anatomy of the thenar area of the hand: its surgical applications. Plast Reconstr Surg. 1997;99(1):116–21.CrossRefGoogle Scholar
  30. 30.
    Endo T, Nakayama Y. Microtransfers for nail and fingertip replacement. Hand Clin. 2002 Nov;18(4):615–22.CrossRefGoogle Scholar
  31. 31.
    Del Piñal F, Moraleda E, de Piero GH, Ruas JS, Galindo C. Onycho-osteo-cutaneous defects of the thumb reconstructed by partial hallux transfer. J Hand Surg Am. 2014;39(1):29–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Seong Eon Kim
    • 1
  • Hyun Tae Lee
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryPohang SM Christianity HospitalPohang-siSouth Korea

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