Clinical application of modified recipient site incision design in thumb reconstruction

LI Lei; JU Ji-hui; DENG Wei; HOU Rui-xing; LI Guan-xing

doi:10.3969/j.issn.1673-7040.2018.06.002

Abstract：Objective To explore the clinical effect of modified recipient site incision design in thumb reconstruction.Methods From January 2013 to December 2015,6 patients with 6 type ⅡB thumb defects underwent combined wrap-around flap transplantation from the big toe and second toe lateral flap with iliac bone graft.The recipient site was designed with modified incision.Results All wounds healed during the first stage and 6 reconstructed thumbs survived.All feet donor site grafts survived.From 8 to 12 weeks after the surgery,X-ray examination revealed bone union between the bone graft and the thumb phalanx,when the internal fixation was removed.During the follow-up from 10 to 36 months,the appearance of the reconstructed thumbs was similar to the normal one.the thumb had proper nail growth and good perfusion.Sensory recovery reached S3 to S4.Digital opposition and palmar opposition was accomplished in 6 cases.No nonunion or resorption of the grafted bone occurred.Skin graft at the donor sites healed well without ulceration or scar contracture.Skin graft did not affect walking,and patients did not experience cold feet or other discomfort in winter.All patients were satisfied with the results.According to the functional evaluation criteria for thumb and finger reconstruction issued by the Chinese Medical Association,the results were excellent in 4 cases and good in 2 cases.Conclusion Combined wrap-around flap from the big toe and second toe lateral flap with iliac bone graft and modified recipient site incision design is an ideal procedure in the reconstruction of type Ⅱ thumb defects.When compared with the traditional dorsalis pedis flap surgery,it reduces the damage area of the foot donor site without sacrificing any toes.