Avulsive amputations of the thumb: comparison of replantation techniques

Twenty-five cases of avulsive amputation of the thumb are reported. Twenty-one of the 25 cases were categorized as Grade I avulsions (little or no skin defect) and four were categorized as Grade II avulsions complicated by a large skin defect. Three different replantation techniques were used and compared: (1) direct vessel anastomosis, (2) arterial anastomosis between the superficial branch of the radial artery and distal end of the thumb, and (3) arterial anastomosis after artery transfer from other digits. The authors concluded that direct vessel anastomosis was not the preferred method and that technique 2 could be used in any case but was especially suited to Grade II reconstructions. Technique 3 is mainly used in Grade I avulsions.