Imaging Studies

In cases of traumatic injury to the thumb, radiographs should be obtained to determine the presence of fracture and to assess the quality of the IP, MCP, and CMC joints.

In evaluating a child with a congenital malformation of the thumb, radiographs should be obtained to determine the presence or absence of the bones of the thumb, the position of the bones, the quality of the joints, and the presence of any other bony abnormalities.

Treatment & Management

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Media Gallery

Diagram of a Moberg volar advancement flap being used for a thumb tip defect.
Marking for the radial incision of a Moberg flap.
Moberg flap raised just above the level of the flexor pollicis longus tendon sheath.
Markings for a volar advancement flap with modification of the incision at the base to allow closure in V-Y fashion after distal phalanx shortening.
Radial view of the markings for a volar advancement flap with modification of the incision at the base to allow closure in V-Y fashion after distal phalanx shortening.
Volar advancement flap with modification of the incision at the base to allow closure in V-Y fashion after distal phalanx shortening.
Thumb tip defect that is amenable to closure with a Moberg volar advancement flap.
Incision marking for a Moberg flap. The neurovascular bundle should be kept with the volar advancement flap.
Bridging vessel to the neurovascular bundle on a volar flap.
Flexion at the interphalangeal joint to allow closure.
Volar view of the closure of a thumb defect with a Moberg volar advancement flap.
Radial view of the closure of a thumb defect with a Moberg volar advancement flap.
Diagram of a Littler neurovascular island flap for the coverage of a thumb tip defect.
Intraoperative view of a Littler neurovascular island flap.
Postoperative view of a Littler neurovascular island flap.
Second postoperative view of a Littler neurovascular island flap.
Markings for the pedicle of a first dorsal metacarpal artery flap.
Dissection for a first dorsal metacarpal artery flap.
Isolation of the pedicle for a first dorsal metacarpal artery flap.
Postoperative appearance of a thumb tip after coverage with a first dorsal metacarpal artery flap.
Second view of the postoperative appearance of a thumb after coverage with a first dorsal metacarpal artery flap.
Free tissue transfer of great toe pulp to restore a volar thumb defect.
Markings for a free tissue transfer of great toe pulp to restore a volar thumb defect.
Postoperative view after a free tissue transfer of great toe pulp to restore a volar defect.
Dorsal view of the clinical appearance of a Blauth type IV pouce flottant thumb.
Volar view of the clinical appearance of a Blauth type IV pouce flottant thumb.
Radiograph of a pouce flottant thumb
Pollicized index finger for thumb reconstruction at 2 weeks after surgery.
Functional use of a pollicized index finger at 8 weeks after surgery.

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Author

Reuben A Bueno, Jr, MD Assistant Professor, Department of Surgery, Division of Plastic Surgery, Coordinator of Pediatric Plastic Surgery, Southern Illinois University School of Medicine; Consulting Staff, SIU Physicians and Surgeons, Inc

Reuben A Bueno, Jr, MD is a member of the following medical societies: American Association for Hand Surgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Bradon J Wilhelmi, MD Leonard J Weiner, MD, Professor and Chief of Plastic Surgery, Plastic Surgery Residency Program Director, Hiram J Polk, Jr, MD, Department of Surgery, University of Louisville School of Medicine

Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Clinical Anatomists, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association for Surgical Education, Plastic Surgery Research Council, Wound Healing Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

N Ake Nystrom, MD, PhD Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedics Overseas, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Thumb Reconstruction Workup

Imaging Studies

References

Tables

Contributor Information and Disclosures

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