[Thumb reconstruction with modified free wrap-around flap].

OBJECTIVE:To evaluate the function of the reconstructed thumbs and the donor feet after thumb reconstructions with modified wrap-around flap. METHODS:A total of 65 patients who accepted thumb reconstruction with the modified wrap-around flap between January 2003 and October 2007 were followed up, including 54 males and 11 females with an average age of 33 years (range 15-46 years). There were 12 cases of skin degloving injury and late class I B defect, 44 cases of class II defect and 9 cases of class III A defect. The reconstructed thumbs and donor feet were examined and evaluated. Foot function index-verbal rating scales (FFI-5pt), American Orthopaedic Foot and Ankle Society (AOFAS) for hallux metatarsophalangeal-interphalangeal score, gait analysis and dynamic pedobarography were conducted to 20 patients who were followed up recently. RESULTS:Sixty-five patients were followed up 6-60 months with an average of 22 months. The reconstructed thumbs had aesthetic appearance and satisfactory range of motion. The two-point discrimination was (9.7 +/- 2.8) mm, showing statistically significant difference (P < 0.05) when compared with that of the contralateral normal thumb [(4.2 +/- 1.1) mm]. Full or most length of the donor toes were preserved in 63 patients. The width of remaining plantar strip skin that covered the plantar weight-bearing area was (24.5 +/- 3.7) mm, and its two-point discrimination was (9.0 +/- 2.6) mm; showing no statistically significant difference (P > 0.05) when compared with that of contralateral normal one [(8.1 +/- 1.9) mm]. Of the 20 patients who were followed up recently, the evaluation of the FFI-5pt score showed that the pain scale score was 5.6 +/- 4.5, the disability scale score was 1.2 +/- 2.7, and the FFI-5pt total scale score was 3.2 +/- 2.9. The results of AOFAS clinical rating scale showed that the pain scale score was 34.0 +/- 5.0, the function scale score was 38.7 +/- 4.2, the alignment scale score was 15.0 +/- 0, and the total AOFAS scale score was 87.7 +/- 7.4. There was no statistically significant difference (P > 0.05) in the durations of subphases of the gait cycle between the donor foot and the contralateral normal foot, and in the peak force and force-time integral of the two whole foot. The peak force of the donor toe was significantly smaller than that of the contralateral normal toe (P < 0.05), but there was no significant difference in the peak pressure (P > 0.05); and there were no significant differences in the peak forces and peak pressures of other six anatomical sites of the two feet (P > 0.05). CONCLUSION:Using the modified wrap-around flap for thumb reconstruction, aesthetic and functional thumbs can be obtained, and most of the function of the donor feet can be preserved.