1. Thumb Reconstruction Quiz 5 14/6/1387

2. 22 years old man Industrial machine accident Stiff fingers and absent thumb Photography and physical examinations are as follow

3. photography Volar aspectRadial aspect Dorsal aspect

4. Physical examination

5. 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

6. Soft tissue of the dorsal aspect is near normal

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

8. 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

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

11. Thumb reconstruction

12. Thumb deficiency Traumatic

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

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

15. 1/phalangization Web deepening ◦Simple ◦appearance

16. Transpositional flap

17. Dorsal interosseus flap

19. 3/Microvascular tissue transfers Great toe transfer 2 nd toe transfer Wraparound great toe Free composite transfer

21. Thumb Reconstruction with Foucher Flap Technique

22. Flap design

24. Pedicle dissection

25. Bone harvest

26. Folding

27. Folding

28. Folding

29. folding

30. Passing

31. Flap in new site

32. Bone fixation

33. Donor site coverage

34. Final appearance

35. Bone healing

36. Sensory reconstruction Neurovascular island flap

37. Sensory reconstruction

38. Lateral cutaneus of forearm

39. Lengthening

43. Index pollicization on the thumb stump

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

55. photography Volar aspectLateral view Dorsal aspect