Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumb defect

Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction