Microsurgical reconstruction of a stiff jointless thumb after an avulsion injury.

We demonstrate three types of reconstruction of a stiff jointless thumb after an avulsion injury. In the first type, the skeleton of the thumb was harvested from the iliac crest or from a rib, the cutaneous cover was formed from a forearm flap on the a. radialis. In the second type, the preserved skeleton of the thumb from crushed tissues was transferred to the forearm and from there subsequently used for reconstruction together with the forearm flap. These two types of reconstruction were carried out if the amputation line reached the metacarpophalangeal (MP) joint of the thumb. In an amputation proximally from the MP joint, the skeleton of the thumb was reconstructed with a graft from the fibula on a vascular pedicle. The fibula with the vascular pedicle was transferred to the forearm and sutured in an Y-shape suture to the a. radialis. The tissue block of the forearm flap together with the fibula were subsequently transferred for the reconstruction of the thumb. The fundamental prerequisite for the reconstruction of a stiff jointless thumb were freely mobile three-phalangeal digits which could form a functional unit with the stiff thumb. The reconstructions were performed in 7 patients. The advantages and disadvantages of these particular operation schemes are discussed postoperatively after 2 years.