Revisiting Gillies' "Cocked Hat" Reconstruction for Thumb Reconstruction

A technique for reconstructing a thumb following amputation through the metacarpal phalangeal joint is described. This technique was first described by Gillies and involves bony augmentation with iliac crest bone graft to lengthen the first ray and a random pattern flap to cover and provide durable sensate soft tissue coverage. As opposed to more commonly performed procedures, this technique does not involve microsurgery or any specialized equipment. There are several limitations to this technique, but it remains a good option where resources do not allow more modern reconstructive procedures. We present our use of the technique, which was performed at a forward operating base for a coalition service member.