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Microsurgical Reconstruction

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The Thumb

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Abstract

Microsurgical reconstructive options are available to treat thumb amputation at different levels based on author’s experience. I reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumb reconstruction are summarized. Different microsurgical transfer techniques suggest a great freedom of surgical choices. However, the choices are considerably restricted if all functional and cosmetic requirements are to be met. I recommend individualized surgical design and reconstruction because each case of thumb amputation is unique.

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References

  1. Buncke HJ Jr, Buncke CM, Schulz WP. Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses. Br J Plast Surg. 1966;19:332–7.

    Article  Google Scholar 

  2. Cobbett JR. Free digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb. J Bone Joint Surg Br. 1969;51:677–9.

    Article  CAS  Google Scholar 

  3. Foucher G, Merle M, Maneaud M, et al. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg. 1980;65:616–26.

    Article  CAS  Google Scholar 

  4. Hirase Y, Kojima T, Matsui M. Aesthetic fingertip reconstruction with a free vascularized nail graft: a review of 60 flaps involving partial toe transfers. Plast Reconstr Surg. 1997;99:774–84.

    Article  CAS  Google Scholar 

  5. Wei FC, Chen HC, Chuang DCC, et al. Aesthetic refinements in toe-to-hand transfer surgery. Plast Reconstr Surg. 1996;98:485–90.

    Article  CAS  Google Scholar 

  6. Michon J, Merle M, Bouchon Y, et al. Functional comparison between pollicization and toe-to-hand transfer for thumb reconstruction. J Reconstr Microsurg. 1984;1:103–12.

    Article  CAS  Google Scholar 

  7. Jones NF, Hansen SL, Bates SJ. Toe-to-hand transfers for congenital anomalies of the hand. Hand Clin. 2007;23:129–36.

    Article  Google Scholar 

  8. Nguyen JT, Bakri K, Nguyen EC, et al. Surgical management of subungual melanoma: Mayo Clinic experience of 124 cases. Ann Plast Surg. 2013;71:346–54.

    Article  CAS  Google Scholar 

  9. Kovachevich R, Giuffre JL, Shin AY, Bishop AT. Immediate great toe transfer for thumb reconstruction after tumor resection: report of 3 cases. Ann Plast Surg. 2016;76:280–4.

    Article  CAS  Google Scholar 

  10. Morrison W, O’Brien BM, MacLeod AM. Experience with thumb reconstruction. J Hand Surg Br. 1984;9:223–33.

    Article  CAS  Google Scholar 

  11. Gilbert A. Thumb reconstruction using microvascular techniques. In: Tubiana, editor. The hand, vol. III. Philadelphia: WB Saunders; 1988. p. P1142–51.

    Google Scholar 

  12. Zhu J, Hu B. Sonography of the first dorsal metatarsal artery of the foot. J Clin Ultrasound. 2006;34:1–4.

    Article  Google Scholar 

  13. Xu L, Yang K, Wei P, et al. Computed tomography angiography allows the classification of the first dorsal metatarsal arteries. J Reconstr Microsurg. 2016;32:675–82.

    Article  Google Scholar 

  14. Hou Z, Zou J, Wang Z, Zhong S. Anatomical classification of the first dorsal metatarsal artery and its clinical application. Plast Reconstr Surg. 2013;132:1028e–39e.

    Article  CAS  Google Scholar 

  15. Wei FC, Silverman RT, Hsu WM. Retrograde dissection of the vascular pedicle in toe harvest. Plast Reconstr Surg. 1995;96:1211–4.

    Article  CAS  Google Scholar 

  16. Woo SH, Seul JH. Distal thumb reconstruction with a great toe partial-nail preserving transfer technique. Plast Reconstr Surg. 1998;101:114–9.

    Article  CAS  Google Scholar 

  17. Buncke HJ, Valauri FA. Reconstruction of the thumb with a trimmed-toe transfer technique (Discussion). Plast Reconstr Surg. 1988;82:514–5.

    Article  Google Scholar 

  18. Adani R, Cardon LJ, Castagnetti C, Pinelli M. Distal thumb reconstruction using a mini wrap-around flap from the great toe. J Hand Surg Br. 1999;24:437–42.

    Article  CAS  Google Scholar 

  19. Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg [Am]. 1980;5:575–83.

    Article  CAS  Google Scholar 

  20. Pan YW, Zhang L, Tian W, et al. Donor foot morbidity following modified wraparound flap for thumb reconstruction: a follow-up of 69 cases. J Hand Surg [Am]. 2011;36:493–501.

    Article  Google Scholar 

  21. Shen XF, Mi JY, Xue MY, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: long-term follow-up. Plast Reconstr Surg. 2016;138:155–63.

    Article  CAS  Google Scholar 

  22. Wei FC, Chen HC, Chuang CC, et al. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg. 1988;82:506–15.

    Article  CAS  Google Scholar 

  23. Upton J, Mutimer K. A modification of the great-toe transfer for thumb reconstruction. Plast Reconstr Surg. 1988;82:535–8.

    Article  CAS  Google Scholar 

  24. Tsai TM, Aziz W. Toe-to-thumb transfer: a new technique. Plast Reconstr Surg. 1991;88:149–53.

    Article  CAS  Google Scholar 

  25. Iglesias M, Butron P, Serrano A. Thumb reconstruction with extended twisted toe flap. J Hand Surg [Am]. 1995;20:731–6.

    Article  CAS  Google Scholar 

  26. Kempny T, Paroulek J, Marik V, et al. Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice. Plast Reconstr Surg. 2013;131:871e–9e.

    Article  CAS  Google Scholar 

  27. Zhang G, Ju J, Li L, et al. Combined foot flaps with iliac bone graft for reconstruction of the thumb. J Hand Surg Eur. 2016;41:745–52.

    Article  CAS  Google Scholar 

  28. Barca F, Santi A, Tartoni PL, et al. Gait analysis of the donor foot in microsurgical reconstruction of the thumb. Foot Ankle Int. 1995;16:201–6.

    Article  CAS  Google Scholar 

  29. Zhao J, Tien HY, Abdullah S, et al. Aesthetic refinements in second toe-to-thumb transfer surgery. Plast Reconstr Surg. 2010;126:2052–9.

    Article  CAS  Google Scholar 

  30. del Piñal F, García-Bernal FJ, Regalado J, et al. A technique to improve foot appearance after trimmed toe or hallux harvesting. J Hand Surg [Am]. 2007;32:409–13.

    Article  Google Scholar 

  31. Al-Qattan MM. Pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint. J Hand Surg Eur. 2016;41:295–300.

    Article  CAS  Google Scholar 

  32. Woo SH, Seul JH. Various functioning free muscle transfer for restoration of hand function. J Korean Soc Surg Hand. 2002;7:130–8.

    Google Scholar 

  33. Ishida O, Taniguchi Y, Sunagawa T, et al. Pollicization of the index finger for traumatic thumb amputation. Plast Reconstr Surg. 2006;117:909–14.

    Article  CAS  Google Scholar 

  34. Sosin M, Lin CH, Steinberg J, et al. Functional donor site morbidity after vascularized toe transfer procedures: a review of the literature and biomechanical consideration for surgical site selection. Ann Plast Surg. 2016;76:735–42.

    Article  CAS  Google Scholar 

  35. Lipton HA, May JW Jr, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg [Am]. 1987;12:66–9.

    Article  CAS  Google Scholar 

  36. Poppen NK, Mann RA, O’Konski M, et al. Amputation of the great toe. Foot Ankle. 1981;1:333–7.

    Article  CAS  Google Scholar 

  37. Buncke HJ, Buncke GM, Lineaweaver WC, et al. Bad results after large toe to thumb transplantation. Ann Chir Main Memb Super. 1991;10:513–6.

    Article  CAS  Google Scholar 

  38. Graham DJ, Venkatramani H, Sabapathy SR. Current reconstruction options for traumatic thumb loss. J Hand Surg [Am]. 2016;41:1159–69.

    Article  Google Scholar 

  39. Gu YD, Zhang GM, Chen DS, et al. Toe-to-hand transfer: an analysis of 14 failed cases. J Hand Surg [Am]. 1993;18:823–7.

    Article  CAS  Google Scholar 

  40. Lin YT, Su ST, Lo S, et al. Risk factors for reexploration in toe-to-hand transfer: a multivariate analysis of 363 cases. Plast Reconstr Surg. 2015;135:501–6.

    Article  CAS  Google Scholar 

  41. Lister GD, Kalisman M, Tsai TM. Reconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers. Plast Reconstr Surg. 1983;71:371–86.

    Article  Google Scholar 

  42. Ozkan O, Chen HC, Mardini S, et al. Principles for the management of toe-to-hand transfer in reexploration: toe salvage with a tubed groin flap in the last step. Microsurgery. 2006;26:100–5.

    Article  Google Scholar 

  43. Wei FC, Epstein MD, Chen HC, et al. Microsurgical reconstruction of distal digits following mutilating hand injuries: results in 121 patients. Br J Plast Surg. 1993;46:181–6.

    Article  CAS  Google Scholar 

  44. Rose EH, Hendel P. Primary toe-to-thumb transfer in the acutely avulsed thumb. Plast Reconstr Surg. 1981;67:214–8.

    Article  CAS  Google Scholar 

  45. Demirkan F, Wei FC, Jeng SF, et al. Toe transplantation for isolated index finger amputations distal to the proximal interphalangeal joint. Plast Reconstr Surg. 1999;103:499–507.

    Article  CAS  Google Scholar 

  46. Woo SH, Kim JS, Seul JH. Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases. Plast Reconstr Surg. 2004;113:882–92.

    Article  Google Scholar 

  47. Woo SH, Lee GJ, Kim KC, et al. Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb. Plast Reconstr Surg. 2006;117:1906–15.

    Article  CAS  Google Scholar 

  48. Kotkansalo T, Vilkki S, Elo P, et al. Long-term functional results of microvascular toe-to-thumb reconstruction. J Hand Surg Eur. 2011;36:194–204.

    Article  CAS  Google Scholar 

  49. Huang D, Wang HG, Wu WZ, et al. Functional and aesthetic results of immediate reconstruction of traumatic thumb defects by toe-to-thumb transplantation. Int Orthop. 2011;35:543–7.

    Article  Google Scholar 

  50. Waljee JF, Chung KC. Toe-to-hand transfer: evolving indications and relevant outcomes. J Hand Surg [Am]. 2013;38:1431–4.

    Article  Google Scholar 

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Authors and Affiliations

  1. W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, South Korea

    Sang Hyun Woo

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  1. Sang Hyun Woo
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Editors and Affiliations

  1. W Institute for Hand and Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Korea (Republic of)

    Sang Hyun Woo

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Woo, S.H. (2019). Microsurgical Reconstruction. In: Woo, S. (eds) The Thumb. Springer, Singapore. https://doi.org/10.1007/978-981-10-4400-7_21

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  • DOI: https://doi.org/10.1007/978-981-10-4400-7_21

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  • Print ISBN: 978-981-10-4399-4

  • Online ISBN: 978-981-10-4400-7

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