Soft tissue reconstruction of the thumb: Classification of defects and standardisation of treatment

Abstract

<b><br>Aim:</b> The aim of this article is to share our experience of thumb reconstruction based on the defect and irrespective of the aetiology, and to work towards standardising the treatment for thumb defects.</br> <b><br>Material and method:</b> This study was conducted at the Burns and Plastic Surgery Centre at Hayatabad Medical Complex from 2018 to 2021. Thumb defects were divided into small (<3 cm), medium (4–8 cm) and large defects (>9 cm). Patients were evaluated for complications post-operatively. The data for defect size and defect site was cross-tabulated for reconstructive options with the help of SPSS. Different flaps were performed depending on the site and size of the defect, which were arranged in a schema to develop an algorithm.</br> <b><br>Results:</b> After scrutinising the data, 35 patients qualified for the study, comprising 71.4% (25) males and 28.6% (10) females. The mean age (and SD) was 31.17 +15.8 years. The right thumb was affected in the majority of the study sample (57.1%), and the majority were affected by machine injury or post-traumatic contractures, affecting 25.7% (n = 9) and 22.9% (n = 8), respectively. Injuries to the first web space and distal to the IPJ of the thumb were the most common, accounting for 28.6% (n = 10) each. A first dorsal metacarpal artery flap was the most common flap, followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n = 2, 5.7%) with a complete flap loss in 1 patient (2.9%). Based on the cross-tabulation of flaps against the size and location of defects, an algorithm was developed to help standardise reconstruction of thumb defects.</br> <b><br>Conclusion:</b> Thumb reconstruction is critical in restoring the patient’s hand function. This classification-based, structured approach for thumb reconstruction will help hand surgeons in taking decisions and selecting effective coverage options with minimal complications. Most of these defects can be covered with local, simple flaps without the need for a microvascular reconstruction.</br>