Reconstruction of the thumb with a free wrap-around flap from the big toe and an iliac-bone graft.

Ten patients with an amputated thumb had reconstruction by a free wrap-around flap taken from the big toe, including the nail, and an iliac-bone graft as the core of the reconstruction. The long-term results showed that a better replica of the thumb was achieved. The results were quite satisfactory both cosmetically and functionally, but there were some new problems: resorption of the bone graft, bulging of the pulp, skin atrophy at the base of the thumb, and deformity of the nail in a few patients. Modifications of the flap design and of the shape of the bone graft eliminated these problems nearly entirely.