Bilateral big toe wrap-around flap for reconstruction of the distal segment of the thumb

Objective To introduce the sm＇gical procedure of reconstructing the distal segment of the thumb using combined bilateral big toe wrap-around flap. Methods A partial fibular side wrap-around flap was harvested from both big toes. The flaps were tailored and designed based on measurements taken from the thumb of the intact side. These two flaps were combined like ＂nfirror image＂ to reconstruct the distal segment of the thumb. Results This technique was used in 6 thumbs of 6 cases. All the transplants survived. The patients were follow-up for 3 to 9 months. All reconstructed thumbs had full pulp. Two-point discrimination was 5.0 to 8.0mm. The appearance of the thumb looked real with normal growing nail. There was no impairment of joint movement and thumb function. Donor sites could be directly closed and healed uneventfully. No walking problems were encountered. Conclusion Reconstruction of the distal segment of the thumb using combined bilateral partial big toe wrap-around flap causes less trauma to the donor sites by preserving the shape and nail of the big toes. The appearance of the reconstructed thumb looks near normal. This surgical procedure is an ideal method for fin~er reconstruction. Key words: Finger injuries;  Microsurgery;  Tissue transplantation;  Toes