Microsurgical reconstruction of the traumatized thumb

Amputation of the thumb means serious functional, aesthetic and psychological damage. Thumb reconstruction has been the subject of great interest in recent years and the advent of microsurgery has radically modified the surgical approach. Composite transfer of the hallux or second toe makes it possibile to reconstruct a thumb of sufficient lenght, sensitivity and grip stability and, above all, with and acceptable aesthetic appearance, thanks to the presence of the nail, which is similar to contralateral thumb. The different microsurgical transfer techniques might suggest the existence of a great freedom of choice in therapeutic indications. The different possibilities are, however, considerably restricted if all the factors necessary to arrive at a correct surgical indication are considered. It can be maintained that every case of thumb amputation ideally requires a specific reconstructive procedure. The purpose of the present paper is to describe the use of the various reconstructive techniques on the basis of levels of thumb amputation in the attempt to identify on each occasion the correct technique that enables us to construct a custom-made thumb.