Traumatic thumb amputations are a common problem with significant associated cost to patients, hospitals, and society.The purpose of this study was to review practice patterns for traumatic thumb amputations using the National Trauma Data Bank. By using a large nationwide database, we hoped to better understand the epidemiology and predictors of attempts and successful replantation.The design was a retrospective review of the National Trauma Data Bank between the years 2007 and 2010, investigating patients with traumatic thumb amputations. Analyses of these patients based on replantation attempt, mechanism of injury, and demographics were performed. Comparisons were made between hospitals based on teaching status and on patient volume for replant attempt and success rates.There were 3341 traumatic thumb amputations with 550 (16.5%) attempts at replantation and an overall success rate of 84.9%. Nonteaching hospitals treated 1238 (37.1%) patients, and attempted 123 (9.9%) replantations with a success rate of 80.5%. Teaching hospitals treated 2103 (63.0%) patients, and attempted 427 (20.3%) replantations with a success rate of 86.2%. Being in a teaching hospital increased the odds of attempted replantation by a factor of 3.1 (P < 0.001) when compared to a nonteaching hospital. Treatment at a high-volume center increased the rate of attempted replantation by a factor of 3.4 (P < 0.001), as compared to low-volume hospitals.Practice patterns show that teaching and high-volume hospitals attempt to replant a higher percentage of amputated thumbs. Success rates are similar across practice settings.

A 25-year-old African-American man presented with a 3-year history of recurrent pustules, sinus tracts, and scarring of the scalp and sinus tract formation in the axillae. He was diagnosed with dissecting cellulitis of the scalp and hidradenitis suppurativa.The scalp condition was nonresponsive to trials of oral prednisone and topical and oral clindamycin before presentation to our clinic. Local incision and drainage of lesions and intralesional steroids provided temporary symptomatic relief. He completed two courses of systemic isotretinoin with minimal improvement and failed several months of etanercept, an anti-tumor necrosis factor alpha (TNF-a) inhibitor. Radiation-induced epilation was considered, but his insurance carrier did not approve it. Because the scalp disorder was progressing, disfiguring, and a social stigma for him, he underwent total scalp excision (Figures 1 and 2) followed by split-thickness skin grafting (Figure 3) for definitive therapy. He tolerated the procedure well, experienced relief of symptoms, and was pleased with his final outcome (Figure 4). DiscussionDissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens, is a chronic, relapsing inflammatory disease of the scalp most commonly occurring in African-American men in the second to fourth decades of life. It is acknowledged to be one part of the follicular occlusion triad, along with acne conglobata and hidradenitis suppurativa. 1 The likely mechanism is related to follicular hyperkeratosis and occlusion. Ruptured follicles initiate a neutrophilic and granulomatous inflammatory response. 2 These recurrent inflammatory papules, nodules, pustules, and sinus tracts commonly involve the vertex and occipital scalp. The chronic inflammatory response eventually results in scarring and alopecia, which can be painful and disfiguring. 1