Functional Evaluation of Thumb Reconstruction according to the Level of Amputation

Journal of the Korean Society for Surgery of the Hand 1998;3(2):119-130.
Published online January 1, 1998.

Kwang Suk Lee,Woong Kyo Chung,Jong Woong Park,Dong Hoon Suh

절단부위에 따른 수무지 재건의 기능적 평가

이광석,정웅교,박종웅,서동훈

Abstract

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but its indication has been limited distal to the metacarpophalangeal (MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of 30¡Æflexion and 45¡Æinternal rotation but in 6 cases in the fixation of 30¡Æflexion and 30¡Æinternal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of 30¡Æflexion and 45¡Æinternal rotation for the better functional outcome.