No abstract

Defects of the thumb negatively impact physical and mental health, lead to depression, inferiority complex and hopelessness in the future. The aim of the study was to explore long-term results of thumb reconstruction using autologous transplantation of the second toe with microvascular anastomoses. Material and methods Second toe transplantation for thumb reconstruction was performed for 54 patients. There were 48 male and 6 female patients aged from 12 to 55 years. When analyzing the long-term results of surgical treatment of patients. The anatomy and functionality of the repaired finger was evaluated at a long term measuring the range of motion in the joints, muscle strength of the hand and major types of hand grips. Results The autograft completely healed with opposition of the reconstructed thumb and the rest fingers restored in 51 patients. The autograft failed in three cases treated with less functional methods. Conclusion Microsurgical reconstruction technologies used for a lost thumb facilitated rapid recovery of the finger and significantly improved functions of the injured hand as an entity. Free second toe transplantation using microvascular anastomoses for the thumb reconstruction allowed the patient regain basic gripping functions and improve cosmesis of the injured hand.

Introduction. Traumatic amputations of a thumb may happen as a result of severe mechanical injuries with the primary detachment and destruction of tissues, or following deep burns, frostbites or ischemia. In 70 to 80% of cases of disability and the loss of occupational fitness the key causes are traumatic digit and hand amputations. In 50% of cases the loss of ability to work is due to an amputation of a thumb. This makes the issue of thumb reconstruction a priority in surgery of the hand.Materials and methods. This paper presents our experience in the reconstruction of the functional abilities of the hand in 48 patients with traumatic amputations of a thumb. This was performed with the use of reconstructive plastic microsurgery techniques, namely the free transplantation of a second toe onto the hand. All the patients had a thumb stump at the level of the distal part of the metacarpal bone or the proximal part of the proximal phalanx.Results and discussion. A positive outcome was achieved in 45 out of the 48 patients treated. Autograft necrosis occurred in three cases. For these patients the thumb reconstruction was performed with the use of other, less functional methods. The functional condition of the hand manifested an improvement according to the electromyography data obtained at the maximum tonic tension of the thenar eminence muscles, flexor and extensor muscles of the reconstructed digit. In all the cases the hand strength increased by 40 to 90% after the reconstructive surgery; the authors attribute this to the recovery of the key handgrip abilities. According to Doppler ultrasonography data the blood flow velocity and the level of blood filling increased in the hand treated.Conclusion. The reconstruction of functional abilities of the hand with traumatic thumb amputation must be carried out taking into account the available methods of surgical correction and which one of these would be optimal, the evaluation of the patient’s mental status and his or her drive for the fastest possible recovery of the shape and function of the hand. The free autograft of a second toe in place of the lost thumb with microsurgical vascular anastomoses makes it possible to restore most completely the aesthetic and functional abilities of the hand in the shortest possible timeframe.