Thumb reconstruction by microsurgery.
A variety of vascularized toe tissue transfers are available for reconstruction of the thumb. These procedures may provide length, stability, and motion for pinch and grasp, offer adequate sensibility (average two-point discrimination is 15 mm) for prehension, and esthetically simulate the normal thumb better than previous conventional thumb reconstructive procedures. These one-stage procedures have become relatively reliable when performed by reconstructive surgeons experienced in microsurgery. The approach must be thoroughly planned, the surgery is long and meticulous, but the successful results are rewarding. When the wrap-around method is appropriate, it is the procedure of choice because the great toe is preserved.
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