Reconstruction of the thumb with a free wrap-around flap from the big

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toe and an iliac-bone graft. Doi-K; Kuwata-N; Kawai-S J-Bone-Joint-Surg-Am. 1985 Mar; 67(3): 439-45 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.