Resurfacing of the thumb following major skin loss

The repair of areas of skin loss on the hand and in particular on the thumb demands a careful appraisal of the type of tissue used to close the wound. In this report on the closure of avulsed wounds of the thumb, emphasis is placed on the superiority of local pedicle tissue, as compared with pedicle flaps obtained from a distance. Abundant pedicle skin is available on the dorsum of the hand of close partial or complete circumferential defects of the thumb from the level of the metacarpophalangeal joint distally.The main advantage of a local pedicle flap is that the tissue more closely simulates the physical characteristics of volar skin. Neither local nor distant pedicle flaps regain functional sensation. If sensation is essential for satisfactory function it must be supplied by normally innervated volar skin added to the thumb by means of a neurovascular island flap.