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Thumb Reconstruction

Quiz 5 14/6/1387. Thumb Reconstruction. 22 years old man Industrial machine accident Stiff fingers and absent thumb Photography and physical examinations are as follow. Volar aspect. Radial aspect. photography. Dorsal aspect. Physical examination. Amputation from mid metacarp of thumb.

travis-albert
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Thumb Reconstruction

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  1. Quiz 5 • 14/6/1387 Thumb Reconstruction

  2. 22 years old man • Industrial machine accident • Stiff fingers and absent thumb • Photography and physical examinations are as follow

  3. Volar aspect Radial aspect photography Dorsal aspect

  4. Physical examination

  5. Amputation from mid metacarp of thumb Normal 1st CMC ROM Split thickness skin graft Near complete stiff index Amputated and stiff middle finger Pulp-to-palm distance 4cm. In ring and little finger

  6. Soft tissue of the dorsal aspect is near normal

  7. MP joint of the index and the middle finger are fixed in hyper extension

  8. Radiography reveals the same findings • Normal 1st CMC • 1st metacrpal amputation from mid-shaft • Destroyed 2nd and 3rd MP joint • Middle finger amputation from middle phalanx

  9. How to reconstruct the thumb? • References • Green’s hand surgery • Masquallet Flaps

  10. Thumb reconstruction

  11. Thumb deficiency • Traumatic

  12. The most important part of the hand • Necessary for pinch and powerful grip Thumb

  13. Traumatic Thumb Deficiency Reconstruction • 1-Distal third • 2-Middle third • 3-Proximal third

  14. Web deepening • Simple • appearance 1/phalangization

  15. Transpositional flap

  16. Dorsal interosseus flap

  17. Great toe transfer • 2nd toe transfer • Wraparound great toe • Free composite transfer 3/Microvascular tissue transfers

  18. Technique Thumb Reconstruction with Foucher Flap

  19. Flap design

  20. Flap design

  21. Pedicle dissection

  22. Bone harvest

  23. Folding

  24. Folding

  25. Folding

  26. folding

  27. Passing

  28. Flap in new site

  29. Bone fixation

  30. Donor site coverage

  31. Final appearance

  32. Bone healing

  33. Sensory reconstruction Neurovascular island flap

  34. Sensory reconstruction

  35. Sensory reconstruction Lateral cutaneus of forearm

  36. Lengthening

  37. Index pollicization on the thumb stump

  38. This technique needs a functional digital NV • How about 1st dorsal intermetacarpal a. flap

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