The big toe wrap-around flap combination of the second phalange with the metatarsal to reconstruct the thumb / 中华显微外科杂志

ABSTRACT

Objective To explore the surgical technique and treatment outcomes of the big toe wrap-around flap combination of the second phalange with the metatarsal to reconstruct the thumb. Methods From June,2014 to December, 2016, 6 patients of the thumb defects onⅤdegree, we took the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb. The metatarsal head was truncated nearby the metatarsophalangeal joint,and the metatarsal head was turned 70°-80° from the dorsal side to the plantar side, then recombinated the metatarsal after dealed with the fracture, so it can rebuild the metacarpophalangeal joints and the metacarpal. 6 cases were followed up. Results All cases survived,and they were followed up duing 4 to 24 months after operation. The shape was similar with uninjured sides and the two-point discrimination was 1.0-2.0 cm.The function recovered satis-factorily and the maximum flexion of the metacarpophalangeal joints can reach 50 degrees,at the same time,it has the function of dorsiflexion. They were got bone healing and there was no bone absorption and joint degeneration. The donor foot has no ulceration,and walking without the pain and lameness. According to the Upper Extremity Functional functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,there were excellent in 3 cases and good in 3 cases. Conclusion Combined the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb, it can rebuild the metacarpophalangeal joints and metacarpal, we can get the thumb which have the physiological curvature and the suitable length,the configuration and the function were satisfac-tory.It is an effective method for reconstruction of the thumb defect onⅤdegree.