Osteoplastic thumb ray restoration with or without secondary toe transfer for reconstruction of opposable basic hand function.

BACKGROUND: Mutilating hand injuries result in bone and soft-tissue defects. Osteocutaneous flaps can be used for osteoplastic thumb ray reconstruction as a definitive procedure or followed by toe transfer.

METHODS: Twenty-four hands with thumbs amputated proximal to the metacarpophalangeal joint underwent osteoplastic surgery for first ray bone and soft-tissue reconstruction. The Kapandji classification was used for the evaluation of basic hand function (opposable ulnar and radial components) after osteoplastic surgery and after toe transfer.

RESULTS: Thirteen of 24 osteoplastic neothumbs (54 percent) achieved opposition; the other 11 patients underwent corrective osteotomies or toe transfer on the osteoplastic thumb rays. Five in this group achieved opposition, for an overall result of basic hand function in this series of 83.3 percent (20 of 24). Thirteen of 15 patients (86.7 percent) who had thumb amputations regained basic hand function only after osteoplastic thumb ray reconstruction, and 14 of 15 (93.3 percent) did so after revision. Six of nine patients (66.7 percent) with multiple-digit amputations regained opposition after osteoplastic thumb ray reconstruction and secondary revision. Ten patients received 12 toe flaps, two received sensate flaps, and one received an opponensplasty. Ten patients undergoing toe transfers had an average improvement of 4.1 on the Kapandji scale.

CONCLUSIONS: Osteoplastic thumb ray reconstruction followed by osteotomies or sensate flap transfers can yield satisfactory results for some patients. Optimal functional outcomes are achieved when osteoplastic thumb ray reconstruction is followed by toe transfer.