[A new method of thumb reconstruction using big and second toe elements]

The author's modification of thumb reconstruction using the big and second toe elements is presented. Two separate parts were raised on one common pedicle to form future thumb. The main element including bones, tendons and soft tissues were taken from the second toe. The flap comprising nail radix, matrix and lateral fragment of the second toe pulp was prepared and left in situ. Similar flap was raised on the hallux. Winding of the hallux flap round the second toe part allowed to form nearly normal thumb. The nail radix and matrix were harvested subperiosteally without any bone fragments of distal phalanges. Harvesting of minimum of tissues from the hallux and covering the wound by similar flap from the second toe markedly limited the big toe deformation, typical for this type of procedure. The nail plate of the second toe looked acceptable on the slightly thinner hallux. Scares were localized out of the weight bearing surfaces. Best indications for this procedure include cases when the thumb is amputated on the proximal phalanx level. Rare anatomical variation of the toe vascularity may restrict application of this method. Individual length differences between the hallux and the second toe sometimes make it difficult to put the hallux flap in the proper position on the thumb. A small hallux valgity may appear when the second toe is too short.