الفهرس 
ACKNOWLEDGEMENT
Anatomy and Biomechanics of the ThumbOnly 14 pages are availabe for public view
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Abstract
The study was conducted on eighty-four patients between January 2014 and January2016 in a conjoined collaboration between Plastic Surgery Department, Assiut University hospital, Egypt and Plastic Surgery, Hand and Microsurgery department Ganga hospital and medical center, Coimbatore, India.
The aim of this study is to evaluate different modalities of thumb reconstruction through objective assessment regarding its sensation, stability, length, mobility, Position and pain-free function. Evaluation measures included:- Static and moving 2 point discrimination with a Disk-criminator to assess the innervation density. Semmes-Weinstien Monofilament test to assess the sensory threshold. Grip and pinch strength with a Jamar dynamometer and pinch meter. Pickup test to assess stereognosis. The Kapandji score to assess the opposition. Guided by level of amputation, the eighty-four patients were classified into three groups as follows: The distal third extends from the thumb tip to the interphalangeal joint. The middle third is the portion between interphalangeal joint and the metacarpal neck. The proximal third is from metacarpal neck to the carpometacarpal joint. We concluded that the use of Sensate homodigital anterograde digital artery pedicle flaps (Moberg and V-Y advancement) give bitter results than heterodigital flaps (FDMA and Cross finger). The use of great toe transfer has improved grasping power, grip and pinch strength, compared with osteoplastic reconstruction and gives better results regarding 2PD and monofilament test. When multiple digits are injured, the great toe is preferred to a second toe, because the second toe may not adequately recreate powerful pinch grip. Because the second toe is not critical during the gait cycle, it allows for the entire metatarsophalangeal joint to be harvested. Therefore, this may be the only toe transfer possible for proximal thumb amputations. Osteoplastic reconstruction has the advantage of not sacrificing other digits, is a relatively quick procedure and the sensation is immediate (with an added Littler flap) in contrast with a toe transfer. Functionally, the osteoplastic thumb performs well, but aesthetically it falls far short of a well-done toe transfer. Pollicization is the preferred method of thumb reconstruction for loss at the carpometacarpal joint level. Naturally, the availability of a finger that could be pollicized is a prerequisite for this procedure. Although microsurgical free toe transfer is the most common method for thumb reconstruction, there are several other alternatives that may be of more use in specific injuries.