THUMB RECONSTRUCTION WITH EXTENDED TWISTED TOE FLAP

Twelve amputated thumbs were reconstructed with a neurovascular cutane ous flap from the great toe and an osteotendinous flap from the second toe. Both transfers were dependent on a single vascular pedicle. One of the 12 reconstructions failed. In the remaining 11, the mobility of the metacarpophalangeal joint ranged from 10 degrees to 50 degrees, a nd that of the interphalangeal joint from 10 degrees to 30 degrees. Op position and key pinch were restored, and the shape and volume were si milar to those of the normal thumb. Likewise, the great toe was preser ved, and all patients had a normal gait. This technique preserves the epiphyses for future growth in children and maintains the aesthetic ap pearance of the foot, but it has the disadvantage of involving a lengt hy surgical procedure with a 17% rate of major complications.