Thumb reconstruction--an algorithm.

A patient-oriented treatment algorithm was developed to place in perspective the multiple treatment options available for thumb reconstruction. This algorithm was derived from our experience with 52 patients with congenital thumb hypoplasia or aplasia (n = 10) or traumatic amputations (n = 42). The available options for reconstructive treatment include replantation and revascularization, pollicization, microvascular transfer, lengthening, and web space deepening/lengthening. Using this algorithm, a rational decision can be made on the basis of the length of the remaining digit and the associated injuries. Often, patients with as much as 1 cm of proximal phalanx remaining may have good function and sensibility without reconstruction.