Against all odds: traumatic thumb amputation following ring avulsion injury

Abstract

Background. Replantation of an avulsed digit often poses a surgical challenge even to an experienced microsurgeon. Therefore, it is often difficult to choose the treatment path for traumatic amputation of digit following ring avulsion injury, be it completion amputation or replantation. We discuss the surgical challenges encountered and management strategies used in this case of an unfortunate child who sustained an amputation of his dominant thumb.
 Clinical case. We present the case of a 10-year-old boy who sustained a complete amputation of his right thumb following a ring avulsion injury which was reconstructed with multiple approaches and surgical techniques to address difficulties at different stages. We replanted the avulsed thumb, reconstructed the tendon, soft tissue coverage with the use of allograft skin and local flap, and improvised surgical tactic to overcome complications encountered intra- and post-operative states such as thrombosis of arterial anastomosis and venous congestion.
 Discussion. There is scarce literature on the management of ring avulsion injury of the thumb and to the authors best knowledge, there was only one reported case in children. In the case described here, we report a good outcome with complex reconstructive surgery despite all odds in an attempt to salvage the thumb, especially in a pediatric population. Post-surgical reconstruction, the boy achieved a successful and acceptable outcome in terms of function and aesthetic appearance.
 Conclusion. The journey through replantation of an amputated digit following avulsion injury poses various challenges both to the microsurgeon and patient. The decision of surgical tactics must be tailored and thoroughly reason based on the knowledge, experience, and good microsurgical skill. A good surgical outcome can be achieved even in a complex injury in the pediatric population with careful planning and the right intervention in each complication peri-operative.