An island flap from the middle finger is described which can be used to cover a terminal wound on the thumb and the adjacent palmar and dorsal defects of the thumb. The flap is transferred in two stages: the first stage ensures good skin cover using a simple technique and the second stage is nerve repair, giving good sensory return with correct cortical representation. Since 1977, 64 repairs have been carried out using this island flap. The follow-up, results and complications are discussed.
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