Ten patients with an amputated thumb had reconstruction by a free
wrap-around flap taken from the big toe, including the nail, and an
iliac-bone graft as the core of the reconstruction. The long-term results
showed that a better replica of the thumb was achieved. The results were
quite satisfactory both cosmetically and functionally, but there were some
new problems: resorption of the bone graft, bulging of the pulp, skin
atrophy at the base of the thumb, and deformity of the nail in a few
patients. Modifications of the flap design and of the shape of the bone
graft eliminated these problems nearly entirely.