Modified great toe wrap for thumb reconstruction

Reconstruction of the traumatically amputated thumb can be achieved with good cosmetic and functional results utilizing autogenous bone graft and a neurosensory free wrap-around flap from the great toe. The donor area of the toe is modified to create a wrap-around flap to transfer innervated glabrous skin from the medial and lateral borders of the toe. This modification includes nail and nail matrix while preserving toe length and the important plantar weight-bearing skin of the great toe. A series of three patients who have undergone thumb reconstruction utilizing this method are reported. Postoperative follow-up averages 15 months. Sensory recovery is comparable to that reported in the literature; cosmetic appearance of the thumb and nail growth are good.