Island skin flap with neurovascular pedicle from the dorsum of the index finger for reconstruction of the thumb.

This paper describes the successful reconstruction of badly injured thumbs in nineteen patients with transposition of a neurovascular pedicle island flap from the dorsum of the index finger. The flap has a consistent arterial supply (the first metacarpal artery), good sized veins, and terminal branches of the superficial radial nerve. Five patients had either palmar, dorsal, or circumferential loss of soft tissue from the thumb. Twelve patients had acute traumatic amputations requiring distal thumb reconstruction, and two patients had distal amputations with late reconstruction. In both immediate and late reconstruction, we maintained length and skin coverage with good circulation and sensation. This one-stage operation requires less postoperative care than many other procedures currently in use and may be employed in a wider variety of cases.