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