[Reconstruction of amputated thumb: 20 years of development of techniques and indications]

The loss of a thumb is traumatic on the functional, cosmetic and psychological level. If immediate replantation cannot be successfully accomplished, the surgeon must plan to treat the patient within the first days or, at the latest, within the first weeks following the injury. If the patient is left to "mourn" his lost thumb, he will find it difficult to incorporate his new thumb into his body image and this will compromise the results of a late reconstruction. There is a vast range of therapeutic options, even for cases of severe injury. The most classic treatments include lengthening the first metacarpal, osteoplasty, pollicization of long fingers or stump. These techniques were very common up until the late 1970's at which time microsurgical techniques of partial or total toe transfer became popular. For a short time, there was some opposition between proponents of classic techniques and microsurgeons. In fact, there was a role for each method and classic and microsurgical techniques became complementary. Since 1976, we have performed 196 thumb reconstructions in our department; it is interesting to note that classic techniques were used in 14.1% of cases and microsurgical techniques in 85.7% of cases. Very early on, we decided against the use of the big toe because of the resulting plantar sequelae and preferred use of the second toe (50% of cases). Our experience with the reliability of dissection of big toes has led us to prefer partial toe transfer especially the wrap-around technique of Morrison. The failure rate for microsurgical transfer is 3.6%.