The particularities of thumb replantation and reconstruction

U.A. Kurbanov, A.A. Davlatov, S.M. Dzhanobilova

The experience of the Tajik microsurgery school in replantation and reconstruction of amputated thumb in 194 patients is presented in article. The new tactical and technical developments authors are described, the nearest and remote results of thumb replantation and reconstruction are summarized. The males were 163 (84%), females – 31 (16%). The complete traumatic amputation of thumb – were in 121 (62,4%), incomplete – 73 (37,6%).

Amputations by mechanism of trauma were divided on gillotin (50), lacerated (24), crushed (54), avulsive (41), gunshot (18), scalped (7). The levels of amputations were in the distal phalanx – 66, interphalangeal joint – 27, the main phalanx – 61, metacarpo-phalangeal joint – 25, Ith metacarpal bones – 15.

At incomplete traumatic amputation with compensate blood circulation in 49 cases revascularization was not performed. Replantation and revascularization is carried out in 82 (56,6%) patients. In 27 cases with avulsive and crushed amputation of the thumb blood circulation on main artery was restored by autovenous plasty (3), radial-digital autovenous shunting with recovering of venous drainage by transposition of II ray dorsal vein (20), revascularization and reinnervation of the thumb by transposition of III or IV finger vascular-nervous bundle (4). Replantation and revascularization of thumb ware combined with transposition of radial (2), and groin flap (4). In 4 cases the technique of two stage reconstruction of Ith ray is used. In 5 patients the heterotopic replantation one of amputated long finger in thumb position was performed. In 6 cases bone stump is covered by radial flap and in the second stage is made policisation by transposition of IIth ray in position of thumb.

From 82 replanted and revascularized thumbs survival rate was 82,9% (68) and after reconstructive operation without revascularization in incomplete amputation – 98% (48).

The functional results in all cases were positive, including cases with restriction of the mobilities of thumb.

Keywords: microsurgery , replantation, thumb.

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