[Thumb reconstruction with free neurovascular wrap-around flap (bit-toe skin-nail flap) after traumatic amputation]

From November 1993 until May 1995 there were three cases of traumatic loss of the thumb reconstructed, using the above mentioned method. In two cases, the thumbs were amputated in the region of the first phalanx, in one case in the region of the metacarpophalangeal joint. Thumb reconstruction in the technique described by Morrison et al. (1980) involved the neurovascular wrap-around flap from the ipsilateral greater toe. The flap consisted of 4/5 of the soft-tissue including the nail of the big toe and parts of the distal phalanx as well as the fibular nerve of the toe. The vessels of the flap included the first dorsal metatarsal artery and two branches of the vena saphena magna. This paper details surgical technique, pointing out its advantages and disadvantages and compares it with other procedures.