Functional Reconstruction of Thumb with Tendons from an Amputated Finger in Median Nerve Territory-Oriented Macrodactyly

Abstract Nerve territory-oriented macrodactyly (NTOM) of the hand, particularly involving the median nerve, results in severe enlargement and dysfunction of the thumb and index finger, compromising grasp and pinch functions. We present two paediatric cases managed by ray amputation of the index finger and debulking of the thumb, with a novel approach utilizing tendons from the amputated finger to restore thumb flexion, abduction, and opposition in a single-stage procedure. This technique avoids additional donor-site morbidity and optimizes the use of available structures. Both patients achieved improved hand function and aesthetics, with one attaining near-normal pinch and grip strength and the other achieving early pinch ability postoperatively. Our experience suggests that preoperative planning for the use of these tendons is crucial and that careful intraoperative identification enhances outcomes. This method offers a new reconstructive option for NTOM, emphasizing both functional and cosmetic restoration in this challenging congenital condition.