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KMID : 0378019940370100031
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New Medical Journal
1994 Volume.37 No. 10 p.31 ~ p.41
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Microvascular Toe Transplantation in the Traumatic Thumb Reconstruction
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Abstract
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The hand is an important functioning organ performing the greatest activities, due to be used in nearly every hand maneuver and play a key role in hand functions.
An absent thumb represents a tremendous functional loss because the thumb is essential for grasping large objects, fine manipulation, and opposing the fingers.
The goal of thumb reconstruction is to restore pinch and grasp by creating a thumb of ideal length and appearance with maximum of strength, stability, movement, and sensation.
There are many of the favored conventional methods in the thumb reconstruction, which continue to be useful and valuable in specific patients. With the development of microsurgical technique, the era of thumb reconstruction by free microvascular on stage transfer was also introduced in the form of the toe transfer.
In one operation, toe transplantation can restore all of the demand, because the toe had strong skeletal support, a nail, glabrous skin that can be innervated, and mobile joint. It also has the potential for growth, which is important in children.
From July 1984 to June 1994, We had experienced 23 cases of toe transplantation for reconstruction of the traumatic defective thumbs.
Through the retrospective study of these cases, we got some results and conclusions as follow.
1. Toe transplantation, especially great toe, revealed excellent result in the
recipient site, functionally and cosmetically.
2. The procedure of a "wrap around flap" was more esthetically excellent than any other reconstructive procedures, and suitable in the cases of the failure of the replantation or degloving injuries.
3. The free pulp flaps from the lateral hemipulp of the great toe is the best method for restoration of the sensation and skin quality of the hand pulp.
4. When a part of the thumb has been lost, the missing portion can be replaced with a partial toe transplant, especially as like vascularized small joint transfer from the second toe.
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