Anterior superior malleolus flap and second toe transplantation for thumb reconstruction with soft tissue and first web defect

Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction. Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June, 2008 to January, 2016. There were 9 males and 4 females. The average age was 25 years old, ranging from 18 to 52. There were 3 cases of III-degree thumb defect with soft tissue defect of hand, 6 cases of IV-degree thumb defect with soft tissue defect of hand, 3 cases of single V-degree thumb defect and 1 V-degree thumb defect with soft tissue defect. There were 5 patients accompanied with injury of other fingers of the affected hand. And the thenar muscles were also damaged to a varied degree. There were 10 patients with soft tissue defect before surgery, with the wound surface ranging from 3 cm × 5 cm - 6 cm × 13 cm. And the wound of other 3 cases was closed. After the surgery, follow-up visit was conducted on the appearance, sensation, function, daily life and working condition of reconstructed thumb, the appearance and function condition of donor site. Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily. The average post-operative followed-up time was 5.5 years, ranging from 2.5 to 10.0 years. The appearance of reconstructed thumb was satisfactory, and the temperature sensation, pain sensation and touch sensation were recovered. The two-points discrimination was 8-18 mm. Moreover, the flexion and extension function, opposing function and finger-to-thumb function was recovered, which could meet the demand of daily life and work. The appearance of donor site was satisfactory, without claudication, pain or dysfunction. The survival of transplanted skin area in the calf was good, with no ulcer noticed. According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association, there were 10 cases excellent results, 2 good and 1 fair. Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach. Key words: Anterior superior malleolus flap; Second toe; Thumb; Reconstruction; First web