Objective To explore the clinical application and therapeutic analysis of free wrap-around flap transfers in thumb distal segment defects.Methods From February 2019 to September 2022,the Hand Microscopy Group of the Orthopedics Department of Guizhou Provincial People's Hospital used free wrap-around flap transfers to repair 12 cases of distal thumb defects.Among them,there were 7 cases of free ipsilateral toe-nail flaps and 5 cases of contralateral toenail flaps.There were 8 cases of skin defects at the distal end of the thumb accompanied by radial phalangeal or nail defects,and 4 cases of ulnar phalangeal or nail defects.The phalangeal defects did not exceed the interphalangeal joint.There were 6 cases of crushing injuries,3 cases of mechanical injuries,and 3 cases of cutting injuries.All surgeries were performed with primary debridement and secondary free toenail flap transplantation for repair.The defect area ranged from 2.5 cm×1.5 cm to 3.5 cm× 2.5 cm,and the skin flap had a cutting area of 3.0 cm×2.0 cm to 4.0 cm×3.0 cm,and the toe bone had a cutting length of 0.5 cm to 1.8 cm.9 cases had direct closure of the great toenail flap donor site,and 3 cases had pedicle flap repair.Results All 12 cases of free wrap-around flap transfers survived smoothly,and all these patients were followed up for 3～14 months,with an average of 11 months.Eleven patients with distal thumb defects had good postoperative recovery of the thumb function,with similar texture to the healthy finger and nice appearance.The remaining one had concurrent paronychia of the thumb,which healed well after dressing change.According to the evaluation criteria of the Chinese Society of Hand Surgery for upper limb function,there were 9 cases of excellent,2 cases of good,and 1 case of moderate.According to the evaluation criteria of the British Medical Research Association,the sensation of the skin flaps recovered to S3+.All the donor sites healed with a visible linear scar,and had no functional impact.Conclusion Free wrap-around flap transplantation for thumb defects can reconstruct composite tissue defects in the thumb.It not only restores the appearance,sensation,and function of the thumb,but also causes minimal damage to the donor site,resul-ting in satisfactory therapeutic effects.1t is an ideal clinical application method for Ⅰ～Ⅱ degree of thumb defects.
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