THUMB RECONSTRUCTION BY MICROVASCULAR TECHNIQUES

Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and m anual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm tw o point discrimination, 59% of strength in pinching (compared to norma l side), 30 degrees of range of flexion but with a flessum deformity ( average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale) . Partial toe transfers were useful in amputations at metacarpophalang eal (MP) level and distal to this area. Around MP level, three techniq ues were available: wrap around, Twisted Two Toes and ''bipolar'' leng thening. More distally a ''custom made'' transfer allows to match exac tly the defect. All of these techniques save the great toe length. Whe n a pulp was incorporated in the transfer, two point discrimination av eraged 9 mm and in the entire series the mean pinch strength was 93% n ormal and the mean cosmetic score was 3.5 points. Partial toe transfer s are preferable in cases with any otherwise normal hand, providing go od function and better cosmesis.