Thumb Tip Injuries: Meta-Analysis of Different Reconstruction Options

Mohamed, Ahmed T. A.; Tallal, Raghda E; Gad, Ahmed M; Mabrouk, Amr A

doi:10.21608/ejprs.2023.291384

Thumb Tip Injuries: Meta-Analysis of Different Reconstruction Options

Document Type : Research article

Authors

The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

10.21608/ejprs.2023.291384

Abstract

Background: Thumb tip and pulp defects might cause
serious morbidity for the patient. Loss of the highly specialised
and sensate pulp can have a major impact on overall hand
function in addition to the cosmetic abnormality.
Objective: To highlight the functional, aesthetic outcomes
and postoperative complication for these surgical techniques
in the treatment of thumb tip injuries.
Material and Methods: A comprehensive search of the
literature via electronic databases including Pub Med/ Medline,
Cochrane, Web of Science and Google Scholar. An initial
search was carried out using keywords: Thumb tip injury,
thumb tip amputation, Surgical flaps and Reconstruction.
Studies of different modalities were analyzed and compared
regarding the aesthetic outcome, sensory outcome, range of
motion and rate of complications. Hand surgeons were contacted
to help identifying other published and unpublished
relevant studies.
Results: The main point strength in the current study is
that we have systematically analyzed a wide range of local
and regional thumb tip reconstruction options.
Conclusion: Local and regional options are comparable
in terms of sensory, motor, and aesthetic scores, and patient
satisfaction. However local options are associated with significantly
higher complication rates

Keywords

Main Subjects

Hand and Upper Limb Surgery'

References

Ayad W.M., Taman E.A. and Elsaid M.F.: Local and
Regional Flaps in Thumb Reconstruction. The Egyptian
Journal of Hospital Medicine, 77 (5): 5727-32, 2019.
2- Badash I., Gould D.J. and Patel K.M.: Supermicrosurgery:
History, applications, training and the future. Frontiers
in Surgery, 5: 23, 2018.
3- Wan X., Wang W., Liu J. and Tong T.: Estimating the
sample mean and standard deviation from the sample
size, median, range and/or interquartile range. BMC Med.
Res. Methodol., 14 (1): 1-13, 2016.
4- Chi Z., Lin D., Chen Y., Xue J., Li S., Chu T., et al.:
Routine closure of the donor site with a second dorsal
metacarpal artery flap to avoid the use of a skin graft
after harvest of a first dorsal metacarpal artery flap. J.
Plast. Reconstr. Aesthetic Surg., 71 (6): 870-5, 2018.
5- Chitta M., Malathi L. and Joseph A.: Cross-finger flap to
the thumb: Quest for an alternate donor. Indian Journal
of Plastic Surgery, 53 (2): 287-92, 2020.
6- Chen C., Zhang X., Shao X., Gao S., Wang B. and Liu
D.: Treatment of thumb tip degloving injury using the
modified first dorsal metacarpal artery flap. J. Hand Surg.
Am., 35 (10): 1663-70, 2010.
7- Wang H., Chen C., Li J., Yang X., Zhang H. and Wang
Z.: Modified first dorsal metacarpal artery island flap for
sensory reconstruction of thumb pulp defects. J. Hand
Surg. Eur., Vol. 41 (2): 177-84, 2016.
8- Erken H.Y., Akmaz I., Takka S. and Kiral A.: Reconstruction
of the transverse and dorsal-oblique amputations of
the distal thumb with volar cross-finger flap using the
index finger. J. Hand Surg. Eur., Vol. 40 (4): 392-400,
2015.
9- Zhang T., Jiang L. and Liu H.: Design and functional
evaluation of a dexterous myoelectric hand prosthesis
with biomimetic tactile sensor. IEEE Transactions on
Neural Systems and Rehabilitation Engineering, 26 (7):
1391-9, 2018.
10- Liu H., Regmi S., He Y. and Hou R.: Thumb Tip Defect
Reconstruction Using Neurovascular Island Pedicle Flap
Obtained From Long Finger. Aesthetic Plast. Surg., 40
(5): 755-60, 2016.
11- Couceiro J., de Prado M., Menendez G. and Manteiga Z.:
The first dorsal metacarpal artery flap family: A review.
The Surgery Journal, 4 (4): e215-9, 2018.
12- Lin L.: Bias caused by sampling error in meta-analysis
with small sample sizes. PLoS One, 13 (9), 2018.
13- Horta R., Barbosa R., Oliveira I., Amarante J.M., Marques
M., Cruz Reis J., et al.: Neurosensible reconstruction of
the thumb in an emergency situation: Review of 107
cases. Tech. Hand Up Extrem Surg., 13 (2): 85-9, 2009.
14- Zhang X., He Y., Shao X., Li Y., Wen S. and Zhu H.:
Second Dorsal Metacarpal Artery Flap from the Dorsum
of the Middle Finger for Coverage of Volar Thumb Defect.
J., 34 (8): 1467-73, Hand Surg Am. 2009.
15- Couceiro J. and Sanmartín M.: The Holevich flap revisited:
a comparison with the Foucher flap, case series. Hand
Surg., 19 (3): 469-474, 2014.
16- Woon C.Y., Lee J.Y., and Teoh L.C.: Resurfacing hemipulp
losses of the thumb: The cross finger flap revisited:
Indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann. Plast. Surg., 61: 385-
91, 2018.