Thumb Reconstruction Quiz 5 14/6/1387

22 years old man Industrial machine accident Stiff fingers and absent thumb Photography and physical examinations are as follow

photography Volar aspectRadial aspect Dorsal aspect

Physical examination

Normal 1 st CMC ROM Amputation from mid metacarp of thumb Split thickness skin graft Near complete stiff index Amputated and stiff middle finger Pulp-to-palm distance 4cm. In ring and little finger

Soft tissue of the dorsal aspect is near normal

MP joint of the index and the middle finger are fixed in hyper extension

Radiography reveals the same findings ◦Normal 1 st CMC ◦1 st metacrpal amputation from mid-shaft ◦Destroyed 2 nd and 3 rd MP joint ◦Middle finger amputation from middle phalanx

How to reconstruct the thumb? References ◦Green’s hand surgery ◦Masquallet Flaps

Thumb reconstruction

Thumb deficiency Traumatic

Thumb The most important part of the hand Necessary for pinch and powerful grip

Traumatic Thumb Deficiency Reconstruction 1-Distal third 2-Middle third 3-Proximal third

1/phalangization Web deepening ◦Simple ◦appearance

Transpositional flap

Dorsal interosseus flap

3/Microvascular tissue transfers Great toe transfer 2 nd toe transfer Wraparound great toe Free composite transfer

Thumb Reconstruction with Foucher Flap Technique

Flap design

Pedicle dissection

Bone harvest

Folding

Folding

Folding

folding

Passing

Flap in new site

Bone fixation

Donor site coverage

Final appearance

Bone healing

Sensory reconstruction Neurovascular island flap

Sensory reconstruction

Lateral cutaneus of forearm

Lengthening

Index pollicization on the thumb stump

This technique needs a functional digital NV How about 1 st dorsal intermetacarpal a. flap

photography Volar aspectLateral view Dorsal aspect