[Secondary thumb reconstruction after avulsion or amputation injury with free wrap-around toe flap]

The free wrap-around toe flap, first described by Morrison in 1980, represents an option for a tailor-made reconstruction of the thumb. This technique ensures flexibility, length, sensibility and an excellent aesthetic outcome. The morbidity rate of the donor site is negligibly small. Unfavourable and therefore limiting to the indication is the absence of a possibility for a joint transfer, the lack of growth potential and the risk of bone absorption when using an iliac bone graft. Our small series includes 5 patients with an average follow-up time of 11.4 months (range: 6 - 22 months) treated from 2003 - 2006. The static two-point discrimination on average was 19 mm (range: 4 - 39 mm). All patients describe coldness intolerance. As there is no deficit in performing opposition and pinch power, there is an acceptable motion of all thumb joints. All patients report a good subjective outcome and would undergo the operation once again. In spite of the short follow-up period with moderate to good results, the wrap-around toe flap can be recommended as an appropriate and safe procedure for thumb reconstruction after an avulsion and traumatic amputation.