الفهرس 
Functional Anatomy of the ThumbOnly 14 pages are availabe for public view
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Abstract
The thumb is the most important finger being involved in nearly all hand and arm activities so any injury or tissue defect will greatly affect hand functions. So, during thumb reconstructions it is important to restore sensate and non-tender thumb tip with low donor-site morbidity, full restoration of function and range of motion, and an acceptable aesthetic outcome.
Options used for covering of soft tissue defects of the thumb have evolved by time with increased anatomical knowledge, progress in surgical instruments and available devices, and innovative surgical techniques.
A variety of flaps, which include the volar V-Y advancement flap, cross-finger, Moberg’s flap, Littler flap, and Kite flap, however each of the previously mentioned flaps has its disadvantages.
In this study twenty patients with thumb injury, eighteen males and two females with age ranging from 20 to 55 years with mean age (32±9.81years), were encountered in this study in Menoufia University and Al-ahrar Zagazig Teaching Hospitals. Denoting that males are more exposed to hand injuries than females, especially young age.
Seven surgical approaches are applied and discussed in this study for reconstruction of thumb defects which are: Replantation, Moberg flap, Kite flap (First dorsal metacarpal artery flap), Littler flap (Neurovascular island flap), Digital Artery Perforator flap (DAP flap), Thumb cross finger, Groin flap.
Replantation: should be considered for all thumb amputations proximal to the base of the distal phalanx. A successful result from a replantation involves the restoration of blood flow to the part in addition to successful healing and return to function of all involved structures. If replantation is impossible or fails, other methods of thumb reconstruction may be used.
The Moberg`s flap (volar advancement flap): is the simplest and easier sensate flap used for reconstruction of thumb defects in distal third of distal phalanx of 1–2 cm2. It gives excellent sensation to tip of thumb in one stage operation and less complication as donor morbidity and post-operative disfigurement.
The First dorsal metacarpal artery flap (Kite`s flap): was a reliable local neurovascular island flap for thumb reconstruction, offering acceptable functional and cosmetic outcomes in respect to sensation, elasticity, durability, and skin match. It provides elastic, durable, and sensate coverage for soft tissue defects of the thumb. Donor site morbidity is minimal with an acceptable scar on the dorsum of index and adequate tendon gliding without producing extension deficit. is a first treatment of choice for defects of the proximal phalanx and proximal part of the distal phalanx of the thumb zone 4. Contraindications of the FDMCA flap are circular defects at the proximal or distal phalanx and previous injury at the second metacarpal level.
The heterodigital (Littler’s) flap: was reliable, with good vascular and sensory supply, and provided thumb reconstruction in a single stage with advantage of that hetero digital flap is more suitable for large defects more than 3cm. Litter`s flap(hetero-digital island flap) is another resurfacing method in case of wide loss of the thumb pulp, involves the usage of neurovascular island flaps from middle and ring fingers. It provides protective sensation and an acceptable cosmetic result.