Thumb Reconstruction

DR ALAMZEB KHAN

Plastic SurgeonKing Abdulaziz Specialist Hospital Taif KSA

CLASSIFICATION

CLASSIFICATION(LEVEL OF THUMB LOSS)

COMPONENT LOSS (SOFT TISSUE LOSS OR SEGMENTAL LOSS OF NEUROVASCULAR OR TENDON

SKELETAL COMPONENTS)

AMPUTATION

COMPLETE

Distal subtotal(retaining the entire

metacarpal)

Proximal subtotal subtotal(retaining basal joint

but not thenar muscles)

TOTAL(LOSS OF BASAL JOINT)

Reconstruction According to the level of Amputation

• COMPONENT LOSS HEALING BY SECONDARY INTENTION REVISION AMPUTAION PRIMARY CLOSURE TOE TO THUMB ( WRAP AROUND) LOCAL FAPS

• AMPUTATION( COMPLETE, DISTAL SUBTOTAL) WEB DEEPENING METACARPAL LENGTHENING TOE TO HAND

• AMPUTATION (COMPLETE PROXIMAL SUB TOTAL: TOE TO THUMB OSTEOPLASTIC RECONSTRUCTION OF THE

THUMB DORSAL ROTATION FLAP

• TOTAL AMPUTATION: POLLICIZATION

METACARPAL HAND

METACARPAL HAND

• TYPE I (LEVEL OF FINGER AMPUTATIONS)A. DISTAL TO THE MCP JOINTB.THROUGH THE MCP JOINT BUT THE ARTICULAR SURFACE INTACTC.THROUGH THE MCP JOINT WITH A DAMAGED METACARPAL ARTICULAR SURFACE OR TRANSMETACARPAL AMPUTATION

• TYPE II (LEVEL OF THUMB AMPUTATION) A. DISTAL TO THE METACARPAL NECK B. PROXIMAL TO THE METACARPAL NECK

WITH ADEQUATE THENAR MUSCLE FUNCTION C. ANY LEVEL WITH INADEQUATE THENAR

MUSCULATURE D. ANY LEVEL WITH A DAMAGED CMC JOINT

TREATMENT RECOMMENDATIONS

• TYPE I :• A. (DISTAL TO THE MCP JOINT)

Bilateral second toes for amputations distal to the web space. Combined second and third toes for amputations proximal to the web space (transproximal phalanx transfer).

• B. (THROUGH THE MCP JOINT BUT THE ARTICULAR SURFACE INTACT)

Combined second and third toes (composite joint transfer)• C. (THROUGH THE MCP JOINT WITH A DAMAGED METACARPAL

ARTICULAR SURFACE OR TRANSMETACARPAL AMPUTATION) Combined second and third toes (transmetatarsal transfer)

• TYPE II.• A. (DISTAL TO THE METACARPAL NECK) Whole or trimmed great toe transfer (transproximal phalanx

transfer)

• B. (PROXIMAL TO THE METACARPAL NECK WITH ADEQUATE THENAR MUSCLE FUNCTION)

Distraction or interpositional bone graft followed by whole or trimmed great toe transfer or Transmetatarsal second-toe transfer.

• C. (ANY LEVEL WITH INADEQUATE THENAR MUSCULATURE) Thumb reconstruction in a second stage after finger

reconstruction and Tendon transfer to restore opposition.• D.(ANY LEVEL WITH A DAMAGED CMC JOINT) Same as in IIA and IIB but aiming at reconstructing an immobile

thumb post