[Forum: reconstruction of the traumatic thumb. The thumb in hand mutilations. Indications for reconstructive surgery]

The indications for reconstruction of the thumb in traumatic mutilations of the hand are presented in relation to the various conventional and microsurgical techniques. Several clinical situations are distinguished according to the severity of the hand mutilation and the number of severed fingers. Paucidigital amputations (one or two fingers including the thumb) should be treated by pollicisation or other techniques (Matev, osteoplastic reconstruction, second toe or "custom-made" transfers) depending on whether or not the other fingers need to be preserved. Pluridigital amputations (the thumb and two or three long fingers) require transfer of the 2nd toe or "custom-made" transfers avoiding a further reduction of the digital capital of the hand. Amputations of the five fingers create oblique, transverse or convex sections which, when they are proximal, require elongation of one, two or three digits depending on whether surgery is designed to restore a bipod or tripod pinch grip. Lastly, complex mutilations require a combination of digital reconstruction and palmo-commissural skin repair by neurovascular free flaps from the foot. Nonsurgical management should also be discussed in every case.