Sixty five thumb replantations. A retrospective analysis of factors influencing survival

Sixty five isolated thumb replantations and revascularisations for survival done at our department between 1977 and 1991 were studied retrospectively. The overall failure rate was 20% (13/65). The most important influence on outcome was the mechanism of injury. The failure rate for avulsed thumbs was 38% (6/16), for all other mechanisms of injury 14% (7/49). The failure rates for replantations and revascularisations for survival were similar, 18% (6/33) and 22% (7/32), respectively. The survival rate was independent on the level of injury, the failure rates for amputations at the levels of the proximal and distal phalangeal levels being 19% (6/31) and 21% (7/33), respectively. The presence of two patent arteries at the end of the operation (n = 11) was favourable for the prognosis, as all these thumbs survived. There was no corresponding relationship on the venous side. The use of vein grafts on the arterial or venous side was not associated with lower failure rate. Nine patients were reoperated on, one of them twice. Reoperation was worthwhile, the failure rate in reoperated thumbs being only 11%.