Thumb Replantation: Survival Factors and Re-Exploration in 122 Cases

Abstract

We analyzed 122 cases of replantation following complete amputation of the thumb and correlated various factors with rates of survival. The overall survival rate of thumb replantation was 71%. The type of amputation markedly affected survival rate. In minimally damaged amputations, the time period from injury to the start of surgery was the only significant factor related to survival. Other factors such as age, smoking history, amputation level, the number of vessels reconstructed and the method used did not relate statistically to survival. With avulsion amputations, the survival rate of replantation at and proximal to the MP joint was significantly better than replantation distal to the MP joint. 20 thumbs required re-exploration for vascular compromise; nine of these were salvaged (45%).

Great toe transplant versus thumb replant for isolated thumb amputation: Critical analysis of functional outcome

“…33,[40][41][42][43] The level of injury centered on the proximal phalanx and the IP joint. Nearly half of the injuries were caused by sharp or guillotine type amputations, whereas the other half included avulsion, crush, or blast injuries.…”

Analysis of prognostic factors in ring avulsion injuries

“…[1][2][3] In ring avulsion injuries usually bones and soft tissues are damaged severely and reconstruction is challenging. In spite of the difficulties and the high rate of failure 1,3 the literature contains enough evidence to support attempts to repair those injuries.…”

Salvage of a Thumb Replant Using a Bilobed Dorsal Metacarpal Artery Island Flap: Case Report and Literature Review

“…Whereas initial success with digital replantation and revascularization procedures had a high failure rate, the current series for thumb replantation report successful results from 71% to 91% with sharp injuries nearing 100% [1,12,19]. However, in the face of severe crush injury, multisystem trauma, prolonged delay from time of injury, or unavailability of the amputated part, a microvascular repair may not be feasible and the use of alternative salvage techniques for the preservation of hand function becomes necessary [1,18].…”

“…However, in the face of severe crush injury, multisystem trauma, prolonged delay from time of injury, or unavailability of the amputated part, a microvascular repair may not be feasible and the use of alternative salvage techniques for the preservation of hand function becomes necessary [1,18].…”