Updated: 4/12/2016

Thumb Reconstruction

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Key Images
https://upload.orthobullets.com/topic/6062/images/Thumb illustration_moved.jpg
Regions of Thumb Reconstruction
Region A
Primary closure
Toe to Thumb (wrap around)
Local flaps
Region B
Web deepening
Metacarpal lengthening
Toe to thumb
Region C
Toe to thumb
Osteoplastic thumb reconstruction
Dorsal rotational flap
Region D
  • Reconstruction of the thumb requires an intact carpometarcarpal joint that not only is stable, but is appropriately functional.


  • Toe to thumb procedure
    • great toe receives blood supply from the first dorsal metatarsal artery and dorsalis pedis
      • The Morrison/wrap around flap allow for maintenance of length of the hallux. Size and appearance are best replicated.
    • second toe is not as stable for transfer
      • Vascular pedicle can be based on
        • dorsalis pedis /1st dorsal metatarsal artery
        • 2nd dorsal metatarsal artery
  • Web deepening 
    • Z plasty (2 or 4 flap)
      • 2 flaps provide greater depth
      • if completed at 45 degrees, relative length is increased by 50%; 60 degrees leads to an increase in length of 75%
    • Brand flap
      • index finger is used to provide a full thickness (dermoepidermal flap)
      • can close the donor site primarily
    • Dorsal rectangular flaps
      • Take from dorsum of metacarpals
      • May require skin grafting 
    • Arterialized palmar flap 
    • May use axial or island flaps (locally vs distally)
  • Osteoplastic reconstruction
    • Iliac crest is used to establish mechanical length to the thumb
    • an island flap from the radial aspect of the 4th ray is combined with a reverse radial forearm flap to aid in coverage
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