Reconstruction of traumatic absence of the thumb by alternative microsurgical methods of reconstruction

Because of the improved predictability, relative lack of donor morbidity, and excellent cosmetic appearance associated with the various forms of toe-to-hand transfers, these operations have become the procedure of choice in the reconstruction of a traumatically amputated thumb. However, a transfer from the foot may not always be available. If severe injuries, such as burns, have occurred to the feet, although a transfer may be technically feasible, it should be avoided. Occasionally, a patient will refuse to sacrifice a portion of his or her foot for either cosmetic or cultural reasons. If the presence of significant peripheral vascular disease is documented in the patient, the anatomy and suitability of the vessels supplying the toes becomes entirely unpredictable, and alternative methods for thumb reconstruction should be considered. In the acute trauma setting, first consideration as a source of donor tissue for thumb reconstruction should be given to any other digits, either ipsilateral or contralateral. Any digit amputated or severely injured at or proximal to the proximal interphalangeal joint may be considered as a possible donor digit. Careful examination of the neurovascular structures in this situation is essential to demonstrate that the zone of injury does not prohibit an appropriate repair at the recipient thumb bed. In the nonacute setting, occasionally, digits on the same or opposite hand are a valuable donor source for thumb reconstruction. Any digit found to be nonfunctional for reasons related to its location may be available for amputation and transfer to the thumb.(ABSTRACT TRUNCATED AT 250 WORDS)