Article
The outcomes of the avulsed thumb’s reconstruction
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Authors
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Oxana-Madalina Grosu
- University of Medecine and Pharmacy Gr. T. Popa, Sf. Spiridon Emergengy Hospital, Iasi, Romania
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Sorinel Lunca
- University of Medecine and Pharmacy Gr. T. Popa, Institute of Oncology, Iasi, Romania
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Mihaela Pertea
- University of Medecine and Pharmacy Gr. T. Popa, Sf. Spiridon Emergengy Hospital, Iasi, Romania
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The aim of this paper is to present the functional and esthetic results when using different types of known flaps and, also, when using a combined of these techniques, for thumb reconstruction without microsurgery.
Methods: Our study is based on 42 patients, aged between 25 and 68 years old, who suffered an avulsion trauma and presented complete thumb amputation. In 12 cases, the amputation was at the level of the first phalanx, in 18 cases at the level of interphalangeal joint and in 12 cases at the level of the distal phalanx. For distal amputation, we used H. Rose technique in 5 cases and Hueston flap in 9 cases. In 10 cases of interphalangeal joint amputation, we used Mantero-Bertolotti technique with O'Brien flap. For the other 8 cases of interphalangeal joint amputation and for all cases of the first phalanx amputation, we designed a technique which associated decortication of the amputated segment, its osteosynthesis to the amputation stump and coverage with a neurovascular heterodigital flap (Littler), harvested from the nonfunctional board of the 4th finger, with the length of two phalanges
Results: We evaluated the patients in terms of age, trauma mechanism, surgical technique, mobility, sensitivity, cortical reintegration of the new thumb in those cases in which we used Littler flap, the donor site morbidity, number of days of hospitalization, social and professional reintegration, as well as the patient's satisfaction. In order to test the cortical reintegration of the new thumb, one year after the trauma and reconstruction, we used the light touch deep pressure test, using the minikit Semmens Weinstein monofilaments test. We obtained a low value of the protective sensitivity, but satisfactory. The media of the 2PD (2 point discrimination) test was 6 mm, which is considered to be a good result. For the mobility, we used the Kapandji score, and we obtained values between 7 and 10.
Conclusions: For all of the cases the results in terms of functionality and aesthetics are very good. Using homo or heterodigital flaps, as unique or in association of different techniques, represent a very good solution to reconstruct the amputated thumb whenever the microsurgical replantation is not possible.
