Restoration of thumb with degloving injury and phalangeal fracture using combined island flaps

Objective:To exploit simple operating methods of thumb reconstruction.Methods:We have carried out anatomical observation of cutaneous vessels of the hand. Based upon it, three island flaps were created, including: （1）dorsalmetacarpal island flap supplied by the reverse radial dorsal pollical artery; （2）total dorsal digital island flap supplied by the proper digital artery; （3）island flap of the first web space. Results:The anatomical observation leading to the discoveries as follows: （1）thin communicating branches between dorsal and palmar pollical artery revolve at dorsal side of the first metacarpal bone and surface of the major thenar muscles: （2）proper digital rtery gives off joint branches and dorsal digital branches in the course of advane, the latter obliquely pass to the dorsal digital side and anastomoses with the opponent ones; （3）both principal pollical artery and radial proper index artery give off visible thin branches to skin of the first web space. The flaps designed have been used to restore the thumb in 14 patients. All flaps survived well with satisfactory sensation, appearance and function of restored thumbs.Conclusion:Unless immediate nail restoration is in special request by the patient, thumb restoration using the aforementioned single or combined island flaps of the hand will be available.