History of “Making a Thumb”

Abstract

re The thumb plays an irnportant role in hand function. Daily tasks involving pinch, grip, grasp, and precision handling are more easily accomplished with an thumb. The causes of thumb deficiency are trauuratic loss and congenital anomalies-Auempts to restort thumb function were recorded as early as 1874, when Huguier !l rryorted on the phalangtzation of the thumb metacarpal, which was carried out by deepening the first web space [2]. In 19m, Nicoladoni [3] described a reconsEuction procedure following traumatic amputation of the tlrumb in which a staged, pedicled transfer of the great toe was pr-formed [2]-kvelopment of microsurgical techniques allowed successf,ul transfer of a toe to a thumb in monlaeys in 1965 I4l and in a human in r966 [s]. The loss of a &umb results in a notable functional impairment. Multiple reconstructive pro. cedures have been described to address these deficits. Compared with no reconstruction, any is of benefit. However, each of the described methods offers subtle benefits and downsides and may be more applicable in certain situations. A reconstructed thumb ideally will (l) have adequate length; (2) have a sensate, non-tender tip; (3) have stability; and (4) be positioned to meet the other digits, with an adequate first web space [6]. Littkr I7l analyzed these auritxrtes and believed that although all of them are important" strategic positioning of the thumb is ftre key factor to achieving optimal function. Emphasizing this, he state4 "It is not the full length of the thumb, nor its great strength and movement, but rather its strategic position relative to the fiugers and dre integnty of the specialized terminal prlp tissue which determines prehensile shnrs." TraumaticThumb Defect Lister [8] divided thumb defects into four groups: (l) acceptable length with poor soft tissue coverage ; (21 subtotal amputation with questionable remaining length; (3) total amputation with preservation of the basal joint; and (4) total amputation with loss of the basal joint. 1. Amputation at or distal to the intuphalangeal (IP) joint rarely results in a functional deficit. These cases require a sensate and supple tip, which can be provided by glabrous and non-glabrous skin ffaps. Glabrous flaps include Moberg, V-Y advancement [9], Litder"s neuro-vascular island [10], free toe pulp transfer [1 1], and partial hallux transfer [12]. Nonglabrous skin flaps include the first dorsal metacarpal artery ffoucher) [13], cross-fnger [14, 15], s.