Abstract
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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
Lister G. The choice of procedure following thumb amputation. Clin Orthop Relat Res. 1985;195:45–51.
Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg. 1964;46A:817–25.
Germann G, Sauerbier M, Rudolf KD, Hrabowski M. Management of thumb tip injuries. J Hand Surg Am. 2015;40(3):614–22.
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.
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.
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.
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.
Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg. 2006;117(3):920–6.
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.
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.
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.
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.
Wilkinson TS. Reconstruction of the thumb by radial nerve innervated cross-finger flap. South Med J. 1972;65(8):992–4.
Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg. 1983;72(5):688–97.
Peacock E. Reconstruction of the thumb. In: Flynn JE, editor. Hand surgery. Baltimore: Williams & Wilkins; 1966.
Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am. 1990;15:148–54.
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.
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.
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.
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.
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.
Buncke HJ, Rose EH. Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg. 1979;63(5):607–12.
El-Gammal TA, Wei FC. Microvascular reconstruction of the distal digits by partial toe transfer. Clin Plast Surg. 1997;24(1):49–55.
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.
Kamei K, Ide Y, Kimura T. A new free thenar flap. Plast Reconstr Surg. 1993;92(7):1380–4.
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.
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.
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.
Endo T, Nakayama Y. Microtransfers for nail and fingertip replacement. Hand Clin. 2002 Nov;18(4):615–22.
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.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kim, S.E., Lee, H.T. (2019). Soft Tissue Reconstruction. In: Woo, S. (eds) The Thumb. Springer, Singapore. https://doi.org/10.1007/978-981-10-4400-7_18
Download citation
DOI: https://doi.org/10.1007/978-981-10-4400-7_18
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-4399-4
Online ISBN: 978-981-10-4400-7
eBook Packages: MedicineMedicine (R0)