| Immediate Partial Great-Toe Transfer for the Reconstruction of the Composite Defects of the Distal Thumb |
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Sang Hyun Woo, Gi Jun Lee, Kyung Chul Kim, Joo Sung Kim |
| 무지 원위부 복합 조직 결손의 재건을 위한 부분 족무지의 즉시 전이술 |
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우상현, 이기준, 김경철, 김주성 |
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| Abstract |
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During the last 11 years, 53 composite defects of thedistal thumbs were successfully reconstructed with immediate partial great toe-to-hand transfers after acute hand injuries. There were 28 cases of emergency toe transfer within 24 hours after acute injuries and rest 25 cases were reconstructed on the 5.5 days after injury. Based on the amputation level of the distal thumb, we classified 3 groups. The group I (n=10) was reconstructed with osteo-onychocutaneous flap from the great toe with partial nail for the partial nail defect with pulp and dorsal skin defect of the distal thumb. In the group II (n=25), osteo-onychocutaneous flap from great toe with whole nail was used to reconstruct the nail bed defect more than 60% of whole width. Partial great toe transfer with arthrodesis of the interphalangeal joint was applied to reconstruct at the amputation on the interphalangeal joint in the group III (n=18). There was no flap failure except 3 cases of partial flap necrosis, which needed reversed island skin flaps for resurfacing. The incidence of the inflammation and re-exploration rate was not significantly different from previously reported papers. On the reconstructed thumb (n=35), the mean static 2-point discrimination was about 7.9 mm. Active range of motion at the interphalangeal joint was averaged 36 degrees in the group I and II. The strength of key-pinch was about 80~85% of the normal side. The grip strength measured by Jamar dynamometer in the group III was averaged about 30~85% of the normal contralateral side. Patient satisfaction, as reflected by the average subjective satisfaction scores for aesthetic appearance and function of the new thumb in the group I and II, were high at 85 to 92 points, respectively. In the group III, it was 70 and 67 points respectively, which was statistically lower than other groups (p<0.05). Immediate reconstruction with partial great toe transfer is the excellent option for the reconstruction of the composite defect of the distal thumb both aesthetically and functionally. |
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