Thumb Reconstruction — Moberg, FDMA, Pollicization, and Toe-to-Thumb Transfer

This episode reviews the core principles of thumb reconstruction, focusing on functional priorities, defect location, flap selection, microsurgery, and congenital thumb reconstruction.Topics include the functional importance of the thumb, including opposition, pinch, grasp, sensation, length, stability, mobility, and appearance. Reconstruction is organized using the classic rule of thirds, dividing thumb defects into distal, middle, and proximal third injuries to guide treatment strategy.Distal thumb reconstruction is reviewed through secondary intention, Moberg advancement flap, cross-finger flap, first dorsal metacarpal artery flap / FDMA kite flap, and Littler neurovascular island flap, with emphasis on sensate glabrous coverage, IP joint flexion contracture, venous congestion, sensory confusion, and the importance of taking fascia with the FDMA flap.Middle and proximal thumb reconstruction are discussed through phalangealization, four-flap Z-plasty, Matev distraction osteogenesis, osteoplastic reconstruction, pollicization, on-top-plasty, and microsurgical toe-to-thumb transfer. The episode compares great toe, trimmed great toe, wraparound flap, and second toe transfer, including donor-site morbidity, proximal defect indications, cobra head deformity prevention, tendon tensioning, and patient-centered aesthetic trade-offs.Additional topics include ulnar collateral ligament injury, Stener lesion, skier’s thumb / gamekeeper’s thumb, Blauth classification, congenital thumb hypoplasia, pouce flottant, pediatric trigger thumb, Notta nodule, and the principle that thumb reconstruction must restore not only mechanics, but also identity and confidence. Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsthumb reconstruction, total thumb reconstruction, Moberg flap, FDMA flap, kite flap, first dorsal metacarpal artery flap, Littler flap, neurovascular island flap, cross-finger flap, thumb tip reconstruction, phalangealization, four-flap Z-plasty, Matev procedure, distraction osteogenesis thumb, osteoplastic thumb reconstruction, toe-to-thumb transfer, great toe transfer, second toe transfer, wraparound flap, pollicization, on-top-plasty, cobra head deformity, thumb UCL injury, Stener lesion, skier’s thumb, gamekeeper’s thumb, Blauth classification, thumb hypoplasia, pouce flottant, pediatric trigger thumb, Notta nodule