[Free microvascular transplantation of parts of the great toe for thumb reconstruction].

PURPOSE/BACKGROUND: A reconstructed thumb has to fulfil the function of opposition, pinch-grip, stability, sufficient length, sufficient sensibility, and painlessness. Next to pollicisation, these requirements can only be met satisfactory by the microvascular free great toe-to-hand transplantation. The goal of a thumb reconstruction is a compromise between an optimal functional and aesthetic outcome and a minimal morbidity of the donor site.

METHOD AND CLINICAL MATERIAL: Depending on the extent of the traumatic thumb defect, not only the fibular part of the ipsilateral great toe but also its adjacent soft tissue and the first web space may be integrated into the vascularized transplant. The distal phalanx is reduced in width on its tibial side to integrate the second digital nerve to the transplant. The rest of the great toe is covered with the remaining sensible tibial flap.

RESULTS: From 1993 to 1998, five male patients have been operated with the described method of partial great toe transfer and an additional deepening of the first web space. All reconstructions passed without complications. All patients present with a protective sensibility and a dynamic two-point discrimination between 8 and 15 mm. The average strength of the reconstructed thumb was 79 %, the strength of pinch-grip 90 % of the healthy thumb.

CONCLUSION: Thumb reconstruction after traumatic amputation distal to the metacarpophalangeal joint can in our hands optimally be managed with free microvascular anastomosed parts of the great toe and its adjacent soft tissues.