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Rotating shaft avulsion amputations of the thumb
C V Bowen1, J Beveridge, R G Milliken
1Department of Orthopaedic Surgery, University Hospital, Saskatoon, Saskatchewan, Canada.
The Journal of Hand Surgery
|January 1, 1991
Summary
Thumb replantation for rotating shaft avulsion amputations can achieve good functional outcomes. Early staged procedures showed success, leading to a shift towards single-stage reconstructions for better thumb function.
Area of Science:
- Hand surgery
- Microsurgery
- Reconstructive surgery
Background:
- Rotating shaft avulsion amputations of the thumb present unique reconstructive challenges.
- Concerns regarding low survival rates historically led to staged surgical approaches.
Purpose of the Study:
- To evaluate the outcomes of thumb replantation using a staged approach for rotating shaft avulsion amputations.
- To assess functional recovery, including grip strength, pinch, and sensory discrimination.
Main Methods:
- A retrospective review of 29 patients treated for thumb avulsion amputations over three years.
- Twenty-three suitable thumbs underwent primary replantation followed by secondary nerve grafting and tendon reconstruction.
- Functional outcomes were assessed at a mean follow-up of 20.5 months.
Main Results:
- Nineteen of twenty-three replanted thumbs survived.
- Achieved mean grip strength was 94.6% and key pinch was 77.1% of the unaffected side.
- Five patients demonstrated two-point discrimination of less than five millimeters.
Conclusions:
- A staged approach to thumb replantation for rotating shaft avulsion amputations can yield successful survival and functional recovery.
- The positive outcomes observed have informed a shift towards performing full reconstructions in a single-stage procedure.