Reconstruction of grade Ⅲ to V thumb defects with free toenail flap combined with second toe composite tissue flap
Objective To explore the clinical efficacy of using free toenail flap combined with second toe bone-joint composite tissue flap to reconstruct degree Ⅲ toV thumb defects.Methods From April 2017 to June 2021,a combination of free toenail flap and second toe composite tissue flap was used to reconstruct 12 patients with degree Ⅲ to V thumb defects,including 7 cases of degree Ⅲ2 defects,3 cases of degree Ⅳdefects,and 2 cases of degree V,defects.In cases of degree Ⅳ and V thumb defects,the second metatarsophalangeal joint was used to reconstruct the metacarpophalangeal joint of the thumb.No metatarsophalangeal joint osteotomy or flipping was performed during the surgery.The shape,sensation,movement,and donor site recovery of the reconstructed thumb were followed up after surgery.Results All 12 cases of thumb reconstruction in this group survived.The postoperative follow-up ranged from 12 to 24 months.All reconstructed thumbs had a similar appearance to normal thumbs,with good healing of the metacarpal and phalangeal bones,satisfactory opposition,flexion and extension functions,and a two-point discrimination of the finger body being 0.8 to 1.5 cm.In all cases,the donor foot had a good appearance and weight-bearing or walking unaffected.According to the hand function score of the Hand Surgery Society of the Chinese Medical Association,there were 4 cases of excellent,6 cases of good,and 2 cases of fair.Conclusion The combination of free toenail flap and second toe bone-joint-tendon composite tissue flap can be used to reconstruct a degree Ⅲ to V thumb defect.Choosing a suitable vascular pedicle can provide sufficient blood supply for the composite tissue flap.Through good intraoperative nerve suturing and early postoperative scientific rehabilitation exercise,the reconstructed thumb has less atrophy and can achieve satisfactory appearance and function.
ThumbTreatment outcomeCombined reconstructionThe first dorsal metatarsal arteryToenail flap
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