Thumb reconstruction by micro-vascular techniques.

Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and manual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm two point discrimination, 59% of strength in pinching (compared to normal side), 30 degrees of range of flexion but with a flessum deformity (average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale). Partial toe transfers were useful in amputations at metacarpophalangeal (MP) level and distal to this area. Around MP level, three techniques were available: wrap around, Twisted Two Toes and "bipolar" lengthening. More distally a "custom made" transfer allows to match exactly the defect. All of these techniques save the great toe length. When a pulp was incorporated in the transfer, two point discrimination averaged 9 mm and in the entire series the mean pinch strength was 93% normal and the mean cosmetic score was 3.5 points. Partial toe transfers are preferable in cases with any otherwise normal hand, providing good function and better cosmesis.