Thumb reconstruction with a big toe microvascular wrap-around flap: a report of fifteen cases

Fifteen thumb reconstructions were performed using the wrap-around procedure. A free wrap-around flap was taken from the big toe, and included the nail, and a part of the distal phalangeal skeleton. An iliac bone graft was added as the core of the reconstruction. One patient had an abnormal metatarsal arterial pattern which made the microsurgical reconstruction impossible, and another patient had early venous failure. Thirteen cases with successful thumb reconstruction were evaluated at an average of 27 months. Sensibility based on moving two-point discrimination ranged from 6 mm to 10 mm, and key pinch strength ranged from 0.5 kg to 3 kg. None of the patients had the problem of bone graft resorption, cold intolerance or social unacceptance after surgery. A postoperative study of the feet by Harris mat revealed an area of increased pressure under the second metatarsal head and the big toe stump. None of the patients experienced difficulty when walking or running on level ground.