Free Transfer of a Paralyzed Contralateral Little Finger for Total Thumb Reconstruction in an Electrical Burn Patient: A Case Report and Literature Review

Reconstruction of the thumb interphalangeal joint from the second toe proximal interphalangeal joint combined with artificial dermis covering: A case report

RATIONALE

Thumb function is one of the most fundamental components of hand function, and a vast majority of hand functions are derived from thumb motion. Injury of the thumb interphalangeal joint has a tremendous impact on the function of the thumb, and damage to the thumb interphalangeal joint (IPJ) caused by trauma is usually accompanied by dislocation of the surrounding skin; therefore, it is particularly important to restore the thumb anatomy and skin coverage.

PATIENT CONCERNS

A 41-year-old woman presented with IPJ disfigurement accompanied by a local skin defect caused by machine compression of her right thumb. Restoring the appearance and function of the thumb is key to this operation.

DIAGNOSES

Open fracture of the right thumb.

INTERVENTIONS

After detailed preoperative and radiographic evaluation, the appearance and function of the thumb were reconstructed by IPJ grafting and artificial dermis covering.

OUTCOMES

At 4 months' follow-up, the patient's visual analogue score was 0, no complications (eg, osteomyelitis, osteolysis, osteoarthritis, and nonunion of the artificial dermis) were observed, and the range of motion of the thumb IPJ returned to 60% of that of the healthy side.

LESSONS

The innovative application of the second toe proximal IPJ flap combined with double-layer artificial dermis covering to reconstruct the thumb IPJ defect not only solves the problem of skin defects in the recipient area after transplantation in previous cases but also restores the beauty of the recipient area, making it easier for patients to accept this surgical program.

Thumb reconstruction with combination of the wrap-around flap prefabricated by medialis pedis perforator flap with nail bed and phalanx banked from the amputated thumb: A case report

Thumb reconstruction has been a very challenging issue for hand surgeons. In this report, we present a case of thumb reconstruction with combination of the wrap-around flap prefabricated by the medialis pedis perforator flap with phalanx and nail bed banked from the amputated thumb. A 22-year-old man suffered from the left thumb amputation as well as large soft tissue defect of hand and comminuted fracture in wrist due to a crush accident. The distal phalanx and nail bed of left thumb were exposed and no suitable vessels for microsurgical anastomosis could be found, resulting in the great difficulty of replantation. After debridement, nail bed of the amputated thumb was dissected and banked on the medial side of foot, while the distal phalanx was buried in the abdominal subcutaneous tissue. The fracture was fixed with an external fixation and the soft tissue defect was covered with a free anterolateral flap. Wound and bone healing was achieved 6 months after the initial treatment. Thumb was reconstructed with combination of the banked phalanx and a wrap-around flap prefabricated by the medialis pedis perforator flap and the banked nail bed. The postoperative course was uneventful with complications from both reconstruction and donor sites. The nail of the reconstructed thumb grew normally. Thumb oppositional function was rebuilt. The patient was satisfied with the aesthetic and functional outcome at 5-year postoperative follow-up. We propose that tissue banked from the nonreplantable amputated thumb could be used for secondary reconstruction with the technique of flap prefabrication.