Reconstruction of the thumb and web space defect with the dorsal skin flap of the second toe
Objective To investigate the surgical method and clinical efficacy of reconstructing the thumb defect and the first web space using the dorsal skin flap of the second toe.Methods From January 2016 to December 2020,Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital according to the size and shape of different degrees of thumb defects and skin defects of the first web,the second toe with dorsal skin flap was designed to reconstruct 15 cases of thumbs class Ⅱ,zone A,above defects and the first web.Results All the reconstructed thumb and flaps of 15 cases survived in one stage without vascular crisis.Follow-up time was from 12 to 20 months,with an average of 16 months.The reconstructed thumb has a satisfactory appearance,with no obvious swelling in the web space flap,no contraction in the web space,normal skin color,and no pigmentation.The 2-PD of the thumb tip of the reconstructed thumb was from 10 to 14 mm,and the 2-PD of the first web flap was from 12 to 14 mm.The active flexion and extension range of the reconstructed thumb joint was about 60° to 90 °.There were 12 cases of little finger opposition,1 case of middle finger opposition,2 cases of index finger opposition,10 cases of active opposition,2 cases of active opposition limited,and 3 cases of active and passive opposition limited,nail growth was good,the appearance was smooth.According to the evaluation criteria for finger replantation and reconstruction function of the Chinese Society of Hand Surgery,excellent 12 fingers,good 1 finger,fair 2 fingers,with an excellent rate of 86.7％.The incisions in the foot donor area all healed in stage I,with no necrosis or pain after skin grafting,normal walking,and satisfactory appearance.Conclusion It is a good method to use the second toe with dorsal foot flap to reconstruct the thumb and first web space defect,with a satis-factory postoperative appearance and function.
Thumb defectDorsalis pedis flapFinger reconstructionMicrosurgery
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