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.
Thumb reconstruction Metacarpal lengthening Matev technique Microsurgery Great toe transfer
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Adani R, Woo SH. Microsurgical thumb repair and reconstruction. J Hand Surg Eur. 2017;42(8):771–88.CrossRefGoogle Scholar
Adani R, Tarallo L, Marcoccio I, Fregni U. First web-space reconstruction by the anterolateral thigh flap. J Hand Surg [Am]. 2006;31:640–6.CrossRefGoogle Scholar
Adani R, Corain M, Tarallo L, Fiacchi F. Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer. J Hand Surg [Am]. 2013;38(5):1006–11.CrossRefGoogle Scholar
Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation after traumatic amputation. Hand Clin. 2007;23(1):105–15.CrossRefGoogle Scholar
Cheema TA, Miller S. One-stage osteoplastic reconstruction of the thumb. Tech Hand Up Extrem Surg. 2009;13(3):130–3.CrossRefGoogle Scholar
Del Piñal F, Garcia-Bernal FJ, Delgado J. Is posttraumatic first web contracture avoidable? Prophylactic guidelines and treatment-oriented classification. Plast Reconstr Surg. 2004;113(6):1855–60.CrossRefGoogle Scholar
Del Piñal F, García-Bernal FJ, Delgado J, Regalado J, Sanmartín M, García-Fernández D. Overcoming soft-tissue deficiency in toe-to-hand transfer using a dorsalis pedis fasciosubcutaneous toe free flap: surgical technique. J Hand Surg [Am]. 2005;30(1):111–9.CrossRefGoogle Scholar
Finsen V, Russwurm H. Metacarpal lengthening after traumatic amputation of the thumb. J Bone Joint Surg (Br). 1996;78(1):133–6.CrossRefGoogle Scholar
Gong X, Lu LJ. Reconstruction of severe contracture of the first web space using the reverse posterior interosseous artery flap. J Trauma. 2011;71(6):1745–9.PubMedGoogle Scholar
Graham DJ, Venkatramani H, Sabapathy SR. Current reconstruction options for traumatic thumb loss. J Hand Surg [Am]. 2016;41(12):1159–69.CrossRefGoogle Scholar
Heitmann C, Levin LS. Alternatives to thumb replantation. Plast Reconstr Surg. 2002;110(6):1492–503.PubMedGoogle Scholar
Ishida O, Taniguchi Y, Sunagawa T, Suzuki O, Ochi M. Pollicization of the index finger for traumatic thumb amputation. Plast Reconstr Surg. 2006;117(3):909–14.CrossRefGoogle Scholar
Jones N, Jarrahy R, Kaufman M. Pedicle and free radial forearm flaps for reconstruction of the elbow, wrist and hand. Plast Reconstr Surg. 2008;121(3):887–98.CrossRefGoogle Scholar
Kai S, Zhao J, Jin Z, Wu W, Yang M, Wang Y, Xie C, Yu J. Release of severe post-burn contracture of the first web space using the reverse posterior interosseous flap: our experience with 12 cases. Burns. 2013;39(6):1285–9.CrossRefGoogle Scholar
Muzzaffar AR, Chaoo JJ, Friedrich JB. Posttraumatic thumb reconstruction. Plast Reconstr Surg. 2005;116(5):103e–22e.CrossRefGoogle Scholar
Scheker LR, Lister GD, Wolff TW. The lateral arm free flap in releasing severe contracture of the first web space. J Hand Surg (Br). 1988;13(2):146–50.CrossRefGoogle Scholar
Shin AY, Bishop AT, Berger RA. Microvascular reconstruction of the traumatized thumb. Hand Clin. 1999;15(2):347–71.PubMedGoogle Scholar
Wei FC, Chen HC, Chuang CC, Noordhoff MS. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg. 1988;82(3):506–15.CrossRefGoogle Scholar
Wei FC, Chen HC, Chuang CC, Chen SH. Microsurgical thumb reconstruction with toe transfer: selection of various techniques. Plast Reconstr Surg. 1994;93(2):345–51.CrossRefGoogle Scholar
Wilson JR, Hagood CO Jr, Prather ID. Brown recluse spider bites: a complex problem wound. A brief review and case study. Ostomy Wound Manage. 2005;51(3):59–66.PubMedGoogle Scholar