Reconstruction of the whole thumb for Buck-Gramcko Type ⅢB-ⅢC thumb hypoplasia

CHEN Chao; WANG Zeng-tao; LIU Huan-long; HUANG Xin-liang; WANG Ya-xing; LIU Xiang-run

doi:10.3969/j.issn.2095-252X.2025.08.004

Abstract：Objective To introduce a new microsurgical reconstruction method for severe thumb hypoplasia.Methods From September 1st,2023 to October 14th,2024,a total of 8 sides of Buck-Gramko type ⅢB-ⅢC thumb hypoplasia in 7 patients underwent reconstruction surgery to preserve the thumb.The average age of patients was 10 years old,ranging from 3 to 18 years.The reconstruction method involved transplanting a vascularized osteo-articulo-tendinous flap from the ipsilateral second toe to replace the hypoplastic thumb bone joint,preserving most of the distal phalanx;while simultaneously transplanting an ipsilateral medial plantar flap to reconstruct the thenar contour and skin defect of the thumb.The resected thumb bone joint was transplanted to the foot donor site,and iliac graft was inserted to the remaining bone defect in the second toe.The donor site of the medial plantar flap was reconstructed using a full-thickness skin graft from the inguinal region.The average operation time was 8.25 hours,and the flaps survived completely without vascular crisis after surgery.Results All 8 sides of the thumb were followed up for a period ranging from 2 to 15 months,with an average of 8.5 months.The reconstructed thumbs can achieve stable and flexible pinching function of the index and middle fingers,and the earliest patients in the 4 cases can achieve pinching function to the little finger.The thumb had regained good length and thenar contour,and the patients were highly satisfied.There were no complications in the foot.Conclusions Buck-Gramko ⅢB-ⅢC severe thumb hypoplasia can be treated with this reported microsurgical reconstructive approach to achieve good functional and aesthetic outcome.