ISSN: 1859 - 2872
Reconstruction of thumb amputation without thenar muscles by trimmed great toe transfer
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Abstract
Objective: To evaluate the results of reconstruction of the thumb amputation without thenar muscles by trimmed great toe transfer and the donor site morbidity following the surgery. Subject and method: Prospective study. From December, 2011 to November, 2018, 13 trimmed great toe flaps were transferred to reconstruct thumb stump without thenar muscles in 13 patients (11 males and 2 females) with the average of following-up time was 3 years 5 months (range: 12 months to 78 months). Result: 13/13 flaps survived. 1 case had infection complication of the flexor tendon repair. Secondary outcomes: 2 out of 13 patients did not achieve the basic thumb opposition due to the misposition of the new thumb and required corrective osteotomies in the future. 11 out of 13 patients archived the basic thumb opposition. Of these 11 patients; 8 archived the grip strength > 50% compared to the uninjured side, 8 archived the pinch strength > 30% uninjured side, Kapandji thumb opposition score ranged from 4 to 9; The average score of Michigan hand outcomes questionnaire and the Quick disability of arm, shoulder and hand was 74.7 and 17.1/100 respectively. The average of static 2- point discrimination was 14mm. 2 out of 13 reconstructed thumbs had hyperextension deformity at the metacarpophalangeal joint. In the donor foot: The surgery caused unbalance. However, when wearing shoes or sandals, the patients still did the life activities like stand, walk, take the stairs, jump and run almost normally. 2 out of 13 patients had the new callus at the palmar side around the distal second and third metatarsal area. 4 out of 13 patients suffered medial deviation of the second toe. The average score of foot and ankle disability index was 91.6/100. Conclusion: Trimmed great toe transfer for reconstruction of thumb stumps withour thenar muscles was safe and had good function outcomes. The donor site morbidity did not influence too much to the normal life activities.
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References
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