Application of nail skinflap of big toe connected with tibial flap of second toe in reconstruction of thumb andfirst web

：Objective To introduce13 clinical cases of reconstructing traumatic defect on skin of thumb and first web usingnail skin flap of big toe connectedwith tibial flap of second toe.Methods From May 2003 toApril 2007,a series of 13 case8 of traumatic thumb and first web defect were treated bytransplantation of nail skin flap of big toe connecting with tibial skin flap of secondtoe.Among which two total hand degloving injury cages were included too.Two kind of wayaccording the Gilbert type of the Ist metatarsus dorsal artery were used.Results All thecases were successful and healed by first intention.The contour of reconstructed thumbsshowed to be normal or approximately normal.Follow-up examination were obtained in ninecases for 3-17 postoperative months(average 7 months).Sensations of pain,touch andtemperature recovered.The two-point-discrimination sensation were found to be 7-17 mmrespectively.Opposition measured were 60°-85°(average 75°).All the patients can be backto work and restored activities of daily living.Conclusion In treating soft tissue defectof thumb and first web,transplantation of the nail skin flap of big toe connecting withtibial lateral skin flap Can yield ideal skin covering and exceHent motor function.