Wels and Linz, Austria; and Vysoke nad Jizerou, Ceske Budejovice, and Brno, Czech Republic From the Department of Plastic and Reconstructive Surgery, General Hospital Linz; maz - Microsurgical Training and Research Center; Klinikum Wels-Grieskirchen, Hand Surgery Center; the Department of Plastic Surgery, General Hospital Ceske Budejovice; and the Department of Burns and Reconstructive Surgery, University Hospital Brno.
Plast Reconstr Surg. 2013 Jun;131(6):871e-879e. doi: 10.1097/PRS.0b013e31828bd4a2.
Posttraumatic loss of the thumb is devastating. Toe-to-hand transfer is considered the criterion standard of reconstruction but is associated with donor-site issues. The twisted-toe technique uses parts from the great toe and the second toe, which allows for almost anatomical restoration of the donor foot. The authors present their experience and technical modifications of this method.
Between January of 2003 and November of 2011, 18 patients suffering from loss of thumb because of a variety of indications were treated with the authors' modification of the twisted-toe technique. The neothumb was constructed with a partial onychocutaneous flap from the great toe and an osseotendinous flap from the second toe.
Of 18 transplanted twisted-toe flaps, 17 survived completely (5.6 percent flap loss rate). Similarity of the reconstructed thumb compared with the healthy side was very acceptable in all cases. All patients in whom the procedure was successful were able to use the neothumb in daily life without constraints. Reconstruction of the donor site yielded very acceptable outcomes with a distinct reduction in morbidity and disfigurement compared with conventional toe harvest.
The modified twisted-toe technique is the authors' preferred choice of thumb reconstruction. It allows the reconstructive surgeon to construct a very natural-appearing neothumb with good stability and grip force. In addition, it eliminates many of the donor-site problems associated with pure great toe harvest, by recreating a "neo-great toe" at the donor foot. Although the procedure is more complicated and time-consuming compared with single toe harvest, the authors firmly believe that this extra effort takes thumb reconstruction to a next level.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
外伤性拇指缺失是毁灭性的。足趾移植被认为是重建的金标准，但存在供区问题。扭转足趾技术使用大脚趾和第二脚趾的部分组织，可实现供足的近乎解剖学重建。作者介绍了他们在此技术方面的经验和技术改进。
2003 年 1 月至 2011 年 11 月，作者对 18 例因各种原因导致拇指缺失的患者采用改良的扭转足趾技术进行治疗。新拇指由大脚趾的部分甲床-皮肤瓣和第二脚趾的骨-腱瓣构建。
18 个移植的扭转足趾皮瓣全部存活（皮瓣失活率 5.6%）。所有病例重建拇指与健侧相似，均具有很好的可接受性。所有手术成功的患者均能在日常生活中使用新拇指，没有任何限制。与传统的足趾取材相比，供区重建的效果非常理想，显著降低了发病率和致残率。
改良的扭转足趾技术是作者首选的拇指重建方法。它使重建外科医生能够构建一个非常自然外观的新拇指，具有良好的稳定性和握持力。此外，通过在供足再造“新大脚趾”，消除了与单纯大脚趾取材相关的许多供区问题。尽管与单足趾取材相比，该手术更复杂且耗时，但作者坚信，这额外的努力使拇指重建达到了一个新的水平。
临床问题/证据等级：治疗性，IV 级。
