Functional results of 46 thumb replantations and revascularisations

Abstract

The functional results of 46 patients with isolated thumb replantations and revascularisations were evaluated in the outpatient clinic. The modified system for evaluation of reattached parts proposed by Burton was used. The system for functional evaluation of hands consisted of three major fields: socioeconomic factors, objective assessment and subjective assessment. Certain potential factors which might have influenced the functional results were analysed using Kruskal-Wallis's and Wilcoxon's sum of ranks tests. Level of amputation (P < 0.01) and mechanism of amputation (P < 0.05) significantly influenced the functional result. Age of the patients and severity of amputation (total-subtotal) had no effect on the late results. Thirty-nine patients (85%) had the same employment as before injury. All the patients had economically suitable employment and 31 patients (67%) had the same manual work as before the injury. All but 8 patients experienced cold intolerance. Satisfaction with aesthetic appearance of injured hand differed between sexes: women not being pleased with the sight of their hands in 37% (3/8) and men in 8% (3/38). All patients but one would have the operation again.

Selected Outcomes of Thumb Replantation After Isolated Thumb Amputation Injury

“…12 These results are consistent with those of Janezic et al in nonisolated thumb amputations, which showed that functional outcome is lower in crush and avulsion injuries. 15 However, even skill saw amputations, which are often classified as sharp injuries, may be associated with severe local damage, which differentiates them from other guillotine injuries. 1,16 Our analysis includes these skill saw amputations as sharp injuries, although one could argue for the classification in the crush category.…”

“…Using Burton's system for the evaluation of reattached parts, Janezic et al found that for nonisolated thumb amputations, the best functional outcomes were obtained distal to or including the IP joint, with worse outcomes associated with replants at the level of the carpometacarpal joint or metacarpal. 15 Our data in isolated thumb amputations suggest a similar trend with decreased pinch and grip strengths with more proximal injuries; in fact, we describe a statistically significant difference when comparing the grip strengths of zone I injuries with zone II and III injuries. Other studies do not report on the correlation between zone of injury and mean pinch and grip strengths after replantation of the isolated, amputated thumb.…”

Epidemiology of Upper Extremity Replantation Surgery in the United States

“…1,2 Since that time, thousands of replant procedures have been performed, and the practice has become so ingrained in popular culture that severed body parts of any size or condition nearly always accompany the injured patient to the hospital in the hope that they can be replanted. 3,4 Replantation is complicated and costly. It requires prolonged operative time, long recovery periods, multiple procedures, and motivated patients to achieve optimal outcome.…”

La distraction osseuse progressive au niveau métacarpien ou phalangien chez l'enfant

“…La distraction du cal permet d'améliorer la fonction dans les cas de doigt court sans sacrifice de doigt ou d'orteil et les risques inhérents à tout geste microchirurgical [15]. De plus, la sensibilité distale est toujours conservée après distraction [16].…”