Intraoperative Problems When Replanting an Amputated Thumb

Abstract

This study assessed the problems that should be resolved during replantation surgery for an amputated thumb. A cohort of 23 patients with 23 thumb replants and a mean age of 47.4 years was enrolled. The survival rate of replanted thumbs was 82.6%. For arterial repair, end-to-end methods were applied in 16 thumbs, whereas vein grafts were anastomosed end-to-end to the branch of the radial artery in the anatomical snuff box in seven thumbs or to the proximal stump of the digital artery at the proximal phalanx level in one. Veins were mainly repaired by end-to-end methods. Avulsion of the flexor pollicis longus (FPL) and extensor pollicis longs (EPL) (nine thumbs), digital nerve (three thumbs), and an injured thenar muscle (one thumb) were considered unrepairable. The interphalangeal joint was primarily fused in four thumbs because both the EPL and FPL tendons were unable to be repaired, and no other primary reconstruction was carried out. The use of vein grafting is beneficial for successful replantation of avulsed thumbs. Rather than attempting direct repair of avulsed tendons, primary arthrodesis of the interphalangeal joint may be a useful procedure during replantation in the distal area from zone Ⅲ.