Clinical Study Of Combined Foot Flaps And An Iliac Grafted Bone For Reconstruction Of The Thumb Defects

Objective To explore the methods and clinical effects of combined foot flaps and iliac grafted bone for reconstruction of the thumb defects.Methods 14 patients with thumb defect were reconstructed with combined foot flaps and an iliac grafted bone. A combined great toenail flap and second toe medial flap based on one pedicle with an iliac grafted bone were selected to repair the defects of distal phalanx in five cases. A combined great toenail flap and second toe medial flap based on two pedicles with an iliac grafted bone were selected to repair the defects of distal phalanx in four cases. A combined great toenail flap and dorsalis pedis flap based on one pedicle with an iliac grafted bone were selected to repair amputations through the proximal phalanx in three cases. A combined great toenail flap and dorsalis pedis flap based on two pedicles with an iliac bone graft were selected to repair amputations through the proximal phalanx in two cases.Results The hand wounds healed well in one stage. The reconstructed thumbs in 14 cases survived well. The partial skin on the donor site of the hallux toe was necrosis in one case, and healed well finally through dressing. X-ray examination revealed bone healing between the grafted bone and the thumb phalanx 8~12 weeks after operation while the internal fixation was removed. Patients were followed from 6 months to 60 months. The appearance of the reconstructed thumb was comparable to a normal one. The thumbs had good blood supply and their nails grew well. The recovery sensation ranged from S2 to S4. Range of the motion of the metacarpophalangeal joint in 8 cases whose metacarpophalangeal joints kept intact was from 0°to 70°, and was similar to the range of normal metacarpophalangeal joint. Range of the motion of the interphalangeal joint in 4 cases whose metacarpophalangeal joints and interphalangealjoints kept intact was from 0°to 80°. No motion was observed in 2 cases with metacarpophalangeal joint fusion. Digital opposition and palmar opposition could be accomplished in all 14 cases. Nonunion and resorption of the grafted bone did not occur. According to the standard functional evaluation for the thumb and finger reconstruction issued by Chinese Medical Association, the results were excellent in 11 cases,and good in 3 ones. The donor sites of the flaps healed well without ulcer formation, and all the patients were able to walk without difficult. Linear scar occurred in the iliac donor sites without bitterness. The patients are satisfied with all the results.Conclusion It may be a good method to use combined foot flaps and an iliac grafted bone to reconstruct the thumb. The appearance of the reconstructed thumb is satisfactory and this method doesn’t require sacrifice of the toe.