[Evaluation of late results of reconstructions of the thumb by trimmed great toe method]

Twelve patients with posttraumatic defects of the thumb were treated in the years 1990-1999 by the trimmed great toe method. Eight of them had additional injuries or loss of long fingers (two patients lost all fingers). Reconstruction methods were chosen basing on the amputation level. A fragment of the trimmed great toe of an appropriate length was used distally to the distal part of the first metacarpal according to the technique described by Wei (9 patients). In cases of a more proximal amputation only a distal part of the great toe was used. Pollicisation of other elements of the index with simultaneous free transfer of the great toe distal part was carried out in two patients with index amputations. Bone stabilization was secured by K wires. Arthrodesis was performed in three patients. Tendons were sutured in eight patients In every case anastomosis of the dorsal pedis artery, saphenous vein and two toe digital nerves were performed (additionally the toe plantar artery was anastomosed in two patients and branches of the superficial peroneal nerve were anastomosed in seven patients). Immobilization was applied for four weeks on the foot and six weeks on the hand. All the transferred trimmed great toes survived completely. The hand wounds healed after two weeks, the foot wounds 2-7 weeks (twenty eight days on average). Late results were evaluated 1-9 years after reconstruction. 2PD was 6-14 mm. Thumb length was similar to the contralateral ones and the average range of motion in i.p. join was 3 degrees. According to the patients the results were very good.