[The hypermobile skin- and soft-tissue tube in thumb reconstruction]

Reconstruction of an amputated thumb using a bone graft covered by a tubed skin pedicle gives good results if sufficient vascular supply and sensory innervation is transferred to the reconstructed thumb by a neruovascular island pedicle flap and if the skin and soft tissue tube is fixed well enough to the bone graft. Hypermobility of the skin prevents firm and accurate gripping. Fixation of the skin tube to the bone is best achieved at the time of neurovascular pedicle transfer. At the margin of the skin incision a strip of dermis is left and screwed to the periosteum. This method has been described by CHASE. If hypermobility of the skin persists after the neurovascular pedicle has been transferred the skin can be fixed to the bone using strips of fascia, dermis or lyodura. The operative technique of this procedure is described in detail.