Two toe pedicle flaps combined with skin grafting for reconstructing the distal phalanx of the thumb

The distal phalanx of the thumb is reconstructed mainly with a wrap-around flap. However, this approach tends to cause the loss of the distal phalanx of the toe. In this study, the methods for reconstructing the distal phalanx of the thumb using a wrap-around flap from the great toe and a tibial flap from the second toe were analysed retrospectively. The clinical efficiency of this method was also investigated. Free wrap-around flap creation, tibial flap creation from the second toe, and iliac bone graft repair were performed on 12 patients with loss of the distal phalanx of the thumb. Conversely, a free wrap-around flap from the big toe of the same side and a tibial flap from the second toe were created to repair the degloving injury of the thumb of another eight patients. Thus, the study included a total of 20 patients. All 20 skin flaps successfully survived after 6-60 months. The patients were satisfied with the appearance of their thumb. They also reported being able to use their repaired thumbs to grasp, nip, and pick up needles. The donor sites did not show scars, contractures, or ulcerations. No toe deformity was reported, and the foot activity was not affected. The application of a wrap-around flap and a tibial flap from the second toe in the reconstruction of the distal phalanx of the thumb effectively restores the appearance and function of the thumb