The hand injuries are becoming frequent with the increasing use of mechanical, industrial and household appliances and the hand is easily exposed to the external environment. The hand is more delicate organ than another. The thumb is the most important in the hand and loss of it results in severely diminished function of the hand for pinch and grasp.
Innovative surgeons have developed numerous reconstructive methods in an effort to re-establish effective thumb function. Buncke", experimenting with Rhesus monkeys, successfully transferred the big toe to the hand in 1965.
Cobbett*, in 1968, transferred the big toe to the hand in a 32 year old man for the first successful clinical case. In the following years, microvascular sugeons throughout the world led by pioneers Buncke1 and O´Brien3), transplanted vascularized toes to the hand with a high degree of success, Morison" added the "wrap-around" procedure and it was resolved the defect of big toe-to-thumb method. Many procedures are developed for thumb reconstruction, but they were limited of inappropriate function, secondary defect and cosmetically. So we studied wrap-around procedure with composite neurovascular flap.
Especially the bone was fixed with K-wire or interosseous wire. The interosseous wire fixation was good in stability and bony union. The donor site defects were covered by cross toe flap and full thickness skin graft for weight bearing and padding.
From July 1987 to July 1988, we experienced four cases of wrap-around procedure for thumb reconstruction. The results were good cosmetically
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