[Thumb reconstruction with microsurgical wrap-around neurovascular flap from big toe]

A 27-year-old man had his right dominant thumb amputated, together with skin from the dorsal area of the first metacarpal. Reconstruction was performed using a neurovascular flap taken from his right big toe. It consisted of skin and two-thirds of the distal phalanx, including the nail bed and digital plantar nerves. The vascular pedicle of the flap was formed by branches of the dorsalis pedis artery and the greater saphenous vein. The flap was wrapped around a bony scaffold formed by an iliac bone graft and inserted into the thumb. The revascularization of the flap was performed by connecting the end of the dorsalis pedis artery to the side of the radial artery, and the end of the greater saphenous vein to the end of cephalic vein. Reinnervation was achieved by connecting the plantar digital nerves to the stumps of the digital nerves of the thumb. 1 year later, the patient expressed full satisfaction with the appearance and good function of his reconstructed thumb.