Francisco del Piñal, MD, Dr Med, Davide Pennazzato, MD, Esteban Urrutia, MD

Hand Clinics Vol. 32, Issue 4, November, Pages 519-531 – © 2016 by Elsevier Inc. All rights reserved.

ABSTRACT (full text pdf. below)

Introduction  Without doubt, the most effective way of restoring the amputated thumb function is by replanting it. Any major effort is justifiable to do so. This article discusses succinctly the classic alternatives and expends more time on others. Box 1 summarizes the ideal methods (the first being replantation, not discussed here) and contains the topics dealt with in this article.

Primary Thumb Reconstruction in a Mutilated Hand

Key points

• Thumb reconstruction is the priority in any reconstructive plan.
• Toe transfer is an effective method of thumb reconstruction.
• Trim toe transfer (from great toe) gives better result than second toe transfer.
• Reducing the donor site morbidity by transfer of second toe to the harvested great toe site increases patient satisfaction and acceptance of the procedure.
• Conventional techniques like pollicization and Littler neurovascular island flap can be helpful in patients who decline toe transfer or do not have toes.

Keywords  Ectopic replantation, toe-to-hand transfer, partial thumb defects, mutilating injuries.

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