Transversely-inset great toe hemi-pulp flap transfer for the reconstruction of a thumb-tip defect.

Thumb-tip defect is a common traumatic disease, and replantation of an amputated thumb-tip is the first choice of treatment when available. When an amputee is not available, local flaps such as volar advancement flap are used for reconstruction. However, it is difficult to cover whole defect area by a local flap when a defect is relatively large. In this report, we present a case of the use of a free great toe hemi-pulp flap transfer to reconstruct a thumb-tip defect. A 69-year-old right-handed male suffered from the right thumb-tip crush amputation in Tamai Zone 2. The distal phalanx and the nail matrix were preserved, and the defect size was 5 cm × 4 cm. The thumb-tip was reconstructed with a free great toe hemi-pulp flap under local anesthesia. The flap included extended subcutaneous adiposal tissue (skin size 4.5 cm × 3 cm; fat size 4.5 cm × 5.5 cm) to reconstruct the nail bed, and was transversely inset at the recipient site to cover the whole area of the defect. The donor site could be primarily closed without skin grafting. At postoperative 6 months, the patient was satisfied with good results of the reconstructed thumb-tip and the donor site. Transversely-inset great toe hemi-pulp flap may be useful to reconstruct a thumb-tip defect, which allows relatively wide defect reconstruction.