Reconstruction of the Thumb Tip

Disruption of the anatomy and physiology of the thumb tip by injury can have an adverse impact on hand function. Normal thumb function requires adequate length, normal mobility, with stable, supple, durable, and sensate soft tissue coverage. Reconstruction of acute thumb-tip injuries must be carefully selected in order to restore normal function. For minor thumb pulp injury, a palmar or lateral V–Y advancement flap, or cross index finger flap may be employed. Substantial thumb-tip injury requires more complex reconstruction. The three principal reconstructions for these injuries are the Moberg, neurovascular island, and first dorsal metacarpal artery flaps and will be the focus of this chapter.