gms | German Medical Science

Objectives: The thumb is the most important finger for the function of the human hand. Therefore, there is great interest in a good reconstruction of the thumb after an injury. There are different ways for reconstruction, depending on the type of injury, tissue damage and patients request. We report a case of a complex thumb reconstruction in a guitarist and music teacher.

Method: A 57-year-old guitarist had an accident with a molding cutter. He had an injury of his right, dominant thumb with an extensive soft tissue defect of the dorsal side, involving the proximal and distal phalanx, including the interphalangeal-joint. The substance defect involved skin with subcutaneus tissue, bone, extensor tendon in zone I/II, germinative matrix and nail. The palmar side of the thumb, including both neurovascular bundles, was not involved. The initial operation at the date of injury was an emergency reconstruction of the thumb with an osteofasciocutaneus flap distally pedicled on the radial artery.

Results: After the emergency reconstruction of the injured thumb, soft tissue healing was good. However, there was an insufficient healing of the bone, so that the thumb was unstable. Four months later, the bone was augmented by an iliac crest transplant, soft tissues were thinned and shaped. After this second operation, bony consolidation was satisfying, verified in a computer tomography. After removal of K-wires, the patient started the rehabilitation program with the ergotherapist. Already two weeks after starting this therapy, he was able to start playing the guitar again. 16 months after the initial injury, he went back to his profession as a music teacher, using a small splint including a guitar pick.

Conclusion: Immediate coverage of hand injuries with substantial defects are leading to good results in the majority of patients. In accordance with other authors, we are convinced by the advantages of emergency reconstruction in such injuries. Nevertheless, secondary corrections are frequently required. In this case, the patient was able to play the guitar and work as a music teacher again. The functional outcome was very satisfying and will be demonstrated by video sequence.