Post-traumatic Thumb Reimplantation
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
Reimplantation is the surgical reattachment of a completely amputated body part with restoration of arterial inflow and venous outflow by microsurgical techniques.
Revascularization, in contrast, refers to restoration of circulation in an incompletely amputated part that remains attached by some tissue bridge.
Why the thumb is special
The thumb contributes approximately 40–50% of overall hand function because of opposition, pinch, grasp and precision function. Therefore, thumb amputation is a strong indication for attempted reimplantation when technically feasible and the patient is suitable.
Indications for Digital Reimplantation
- Thumb amputation at almost any level
- Multiple-digit amputations
- Amputation in children
- Amputation through palm / wrist / forearm in suitable cases
- Single digit distal to insertion of flexor digitorum superficialis in selected cases
Exam pearl:
Thumb reimplantation has a lower threshold than reimplantation of a single non-thumb digit because of the thumb's disproportionate functional importance.
A. Principles of Thumb Reimplantation
Successful reimplantation requires consideration of both survival of the replanted part and eventual useful function.
1. Proper Patient Selection
Assess age, comorbidities, mechanism, level of injury, ischemia time, contamination, occupation and expected function.
2. Minimize Ischemia
Preserve…