[Forum: reconstruction of the traumatic thumb in practice...the surgeon passes!]

The aim of thumb reconstruction is to obtain, within a reasonable time, a thumb with an aesthetic appearance and function as close as possible to those of a normal thumb, leaving a minimum of sequelae at the donor site. The author reviews the various modalities of reconstruction, according to the severity of mutilation of the thumb. In pulp amputations, partial lesions are repaired by a homodigital island pulp flap (subcutaneous or unilateral or bilateral neurovascular pedicle advancement flap); total pulp defects should be treated by toe pulp transfer rather than the neurovascular pedicle conventional heterodigital pulp flap (with nerve anastomosis): hemipulp of the great toe or pulp of the 2nd toe. Several thumb reconstruction procedures can be proposed in digital amputations and the surgeon must be aware of their precise indications: up-to-date osteoplastic reconstruction by osteocutaneous forearm retrograde flaps (radial flap or anterior interosseous flap), progressive elongation of the 1st metacarpal, pollicisation (of the ring finger), microsurgical transfer of a toe (not the great toe because of the sequelae to the foot, but the 2nd toe), exceptionally microsurgical transfer of a (damaged) finger from the other hand. Lastly, with minimal sequelae to the foot, "custom-made" reconstructions allow repair of partial amputations (partial great toe transfers) and complete amputations of the thumb (great toe "wrap-around" flap, "twisted two toes" flap of great toe and 2nd toe) or even complex and multidigital mutilations of the hand (dorso-commissuro-bipulpar foot flap).