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Per Primam thumb replantation for all patients with traumatic amputations
W A Ward1, T M Tsai, W Breidenbach
1University of Louisville, Department of Hand Surgery, Kentucky.
Clinical Orthopaedics and Related Research
|May 1, 1991
Summary
Thumb replantation is recommended for all amputations, as success isn't predictable by injury severity. Even with poor initial blood flow, replantation can succeed, highlighting the value of surgical reexploration.
Area of Science:
- Orthopedic Surgery
- Microsurgery
- Trauma Surgery
Background:
- Thumb amputations present complex reconstructive challenges.
- Successful thumb replantation is crucial for hand function and patient quality of life.
Purpose of the Study:
- To evaluate the outcomes of thumb replantation surgery.
- To identify factors influencing the success rate of thumb replantation.
Main Methods:
- Retrospective review of 42 complete thumb replantations (1980-1984).
- Analysis of injury characteristics, intraoperative findings, and postoperative outcomes.
- Assessment of functional recovery, including range of motion and sensory discrimination.
Main Results:
- Overall success rate was 62% (26 out of 42 replantations).
- Narrow zones of injury correlated with higher survival rates.
- Poor arterial flow (80% failure) and avulsed thumbs (46% survival) had lower success rates.
- Reexploration for perfusion loss succeeded in 60% of cases.
- Average postoperative motion was 68 degrees; static two-point discrimination improved to 11 mm.
Conclusions:
- Thumb replantation should be attempted in all cases, irrespective of injury mechanism or severity.
- Initial poor vascular flow or venous congestion does not preclude successful replantation.
- Prompt reexploration for vascular compromise is beneficial, and vein grafting is not always essential.