gms | German Medical Science

Objectives/Interrogation: Reported clinical effects of the hallux nail flap, the part of the second phalange, the part of the third phalange, the fibular flap of the toe transplanted for remodeling and reconstructing of the defect of the distal thumb or the mid and proximal segment defect of the distal thumb.

Methods: According to the appearance of the toe, the hallux nail flap, the part of the second phalange, the part of the third phalange, the fibular flap of the toe were chosen as the donor. In 45 cases the blood circulation was reconstructed by the use of the artery of the thumb anastomosed to the artery of toe, the vein of the thumb anastomosed to the vein of toe. There were 48 cases of the defect of the distal thumb or the mid and proximal segment defect of the distal thumb.

Results: 47 reconstructed thumb all survived. The fibular flap of the toe was necrosis in one case, which was reconstructed by the Neighbour's flap of phalange. The patients were followed-up from 1 year to 3 years (averaged 1.5 years). According to the upper limb function of the Chinese Medical Association Hand Surgery Society, the upper limb partial function of the evaluation trial standard, excellent in 40 cases, good in 5 cases, fair in 4 cases, the excellent rate was 93.8%.

Conclusion: According to the demands of the patients, flexibly choosing the hallux nail flap, the part of the second phalange, the part of the third phalange, the fibular flap of the toe transplanted for reconstruction the defect of the distal thumb or the mid and proximal segment defect of the distal thumb. What is the principle is "what is missing, what to fill", to achieve good functions and appearance. The transplantation of four kinds of free flap from the great toe was the optimal way to reconstruct the defect of the distal thumb or the mid and proximal segment defect of the distal thumb.