Unfavorable Results of Thumb Reconstruction

Introduction: The history of thumb reconstruction parallels the history of hand surgery. The attributes that make the thumb unique, and that the reconstructive surgeon must assess and try to restore when reconstructing a thumb, are: Position, stability, strength, length, motion, sensibility and appearance. Deficiency in any of these attributes can reduce the utility of the reconstructed thumb. A detailed assessment of the patient and his requirements needs to be performed before embarking on a thumb reconstruction. Most unsatisfactory results can be attributed to wrong choice of procedure. Component defects of the thumb are commonly treated by tissue from adjacent fingers, hand or forearm. With refinements in microsurgery, the foot has become a major source of tissue for component replacement in the thumb. Bone lengthening, osteoplastic reconstruction, pollicization, and toe to hand transfers are the commonest methods of thumb reconstruction. Unfavorable results can be classified as functional and aesthetic. Some are common to all types of procedures. However each type of reconstruction has its own unique set of problems. Meticulous planning and execution is essential to give an aesthetic and functionally useful thumb. Secondary surgeries like tendon transfers, bone grafting, debulking, arthrodesis, may be required to correct deficiencies in the reconstruction. Attention needs to be paid to the donor site as well.

Methodology and Material: The authors have reviewed their results with thumb reconstruction for traumatic and congenital defects of the thumb, and have analyzed the results, and the various causes of unfavorable results if any. Various methods were used by the authors to reconstruct the thumb, such as thumb lengthening, radial artery flap, great toe transfer, second toe transfer, and component reconstruction. For each method, the causes for unfavorable results, and ways to avoid them, are presented.

Results: The authors’ analysis of unfavorable results in thumb reconstruction were reported in the Indian Journal of Plastic Surgery (Kumta SM. Unfavorable results in thumb reconstruction. Indian J Plast Surg 2013;46:294-302)

Conclusions: A wide range of procedures are available to reconstruct the amputated thumb. Microsurgery has provided numerous options to reconstruct part or whole of the thumb. Proper assessment of the patient enables the surgeon to choose the correct procedure. If planned and executed meticulously, the results of thumb reconstruction can be excellent. Diligent post-operative care, supervised rehabilitation therapy, and early intervention for secondary procedures to treat complications or unfavorable results, can make the difference between a good and an excellent result.