1. With traumatic loss of the terminal volar pad of a thumb or index digit, the neurovascular island pedicle can serve as an immediate or secondary replacement in preference to a free graft or cross-finger pedicle.
2. A thumb reconstruction with pedicle covering alone has disadvantages of non-critical sensation and susceptibility to ulceration. Improved functional results are obtained when critical sensation and durability are secured by a neurovascular island flap. This supplemental measure sanctions the reconstruction of a thumb by pedicle and bone-graft procedures.