| Objective: To understand the supply first, second toe, the distribution laws of the veins, measure the vessel length and diameter; confirmed feasibility of combination of thumb reconstruction, vascular pedicle in around each other relations; clinical application for the reconstruction of thumb provide anatomical basis.Methods: 10 adult patients with ankle joint were dissected after red latex perfusion.. Observation system supply first, second toe, vein distribution, measurements of vascular diameter and length; simulation free hallux nail flap fitting the second toe composite tissue flap shaping for thumb reconstruction, vascular pedicle in around each other. SPSS18.0 analysis of the data from the statistical software.Results: the first metatarsal dorsal artery in the first and second metatarsal clearance before, plantar metatarsal artery and dorsal metatarsal artery anastomosis; in the first toeweb deep issued two branches: the great toe fibular toe artery and the second toe tibial toe artery. Hallux fibular side of the great toe toe artery length 1.82 ± 0.12 cm, diameter 1.08 ± 0.06mm; tibial side of the second toe plantar digital artery length 0.90 ± 0.16 cm, diameter of 0.82 ± 0.13 MM. The depth of vein of two layers, the first, the two toe dorsal superficial vein flowing into the ankle medial saphenous vein. The simulated thumb is surrounded by a blood vessel pedicle without card pressure.Conclusions: first, second toe, veins can supply hallux nail flap and the second toe composite tissue flap, thumb reconstruction with each other around the vascular pedicle analog card without pressure, suitable for design free hallux nail flap fitting the second toe composite tissue flap for reconstruction of the anatomic features of the thumb.Objective: To evaluate the feasibility of free hallux nail flap of second toe chimeric compound tissue flap to repair thumb defect shaping of thumb reconstruction, and to analyze its clinical curative effect.Methods: 10 cases of the thumb defect were selected Between 2012 October to 2014 October, by using the free hallux nail flap of second toe chimeric composite flap for thumb reconstruction, to observe the survival rate, thumb function evaluation, appearance satisfaction, bone healing time and postoperative complications for the area, and this group of patients as the study group. Before 2012 October were randomly selected using the traditional free two toe to thumb, the first of the 10 cases of patients, as control group. The study group compared with the control group of two cases, the survival rate of the thumb function evaluation, appearance satisfaction, bone healing time and complications of donor area; to observe the clinical effect of free hallux nail flap of second toe chimeric composite flap of thumb reconstruction.Results: The study group(A group): postoperative survival rate of 100% 10 cases of thumb reconstruction; thumb function according to the Chinese Medical Association of hand surgery to the upper extremity functional evaluation criteria, the evaluation was excellent in 8 cases, good in 2 cases; the appearance satisfaction average 94.40 ± 3.31; bone healing time was 6.39 ± 0.81 months; pain mild complications occurred in 2 cases for 3 months, 6 months back to normal. The control group: the thumb reconstruction first toe transplantation group(B group): after 10 cases of thumb reconstruction with 100% survival rate; functional evaluation was excellent in 7 cases, good in 3 cases; the appearance satisfaction 92.8 ± 1.93; bone healing time was 6.36 ± 0.93 months; for early complications in 10 cases, 8 cases of late complications. 5 cases of serious complications. Thumb reconstruction in second toe transplantation group(C group): after 10 cases of thumb reconstruction with 100% survival rate; function was excellent in 2 cases, good in 2 cases, 4 cases, poor in 2 cases; the appearance satisfaction 78.10 ± 7.71; bone healing time was 6.30 ± 0.55 months; for 1 cases of early complications, 6 when the month returned to normal. According to the survival rate, thumb function evaluation, appearance satisfaction, and the healing time of donor site complications, five aspects of research group and the two control groups were statistical analysis. The survival rate was 100%, no statistical significance; and evaluation of donor site complications, respectively, chi square test, P values were less than 0.05, there was statistical significance; the appearance satisfaction variance test, P value is less than 0.05, there was statistical significance; bone healing time variance test, P value is greater than 0.05, no statistical significance.Conclusions: One of the best choices is free hallux nail flap of second toe chimeric composite tissue flap to repair thumb shaped thumb defect in clinical thumb defect reconstruction, which improves the appearance and function of the thumb, and reduce the complications of donor area.
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