Thumb reconstruction by grafting skeletonized amputated phalanges and soft tissue cover – A new technique: A case series

Abstract

This study reports five cases of crush-avulsion injury to the thumb at different levels presented at our plastic and hand surgery unit between 2005 and 2007. All of the patients were male labors with machine injuries to the thumb with non-replantable amputations. Distal phalanx or proximal phalanx, or both, were used as a free cortical bone graft. The amputated part was skeletonized keeping the periosteum attached to the cortical bone of the phalanx fixing it to the stump and covering it by either local flap like dorsal metacarpal flap or regional flaps like the distally based pedicled radial forearm flap and neurovascular island sensate flap or groin flap. The results were functionally and cosmetically good and follow up X rays showed no osteoporotic resorption after one year.

A Successful Non-microsurgical Thumb Reconstruction by Using the Skeletonized Amputated Phalanges, After a Failed Trial of Microsurgical Replantation: A Case Report

“…Similar to our patient, two previous studies had undergone immediate osteoplastic reconstruction with the amputated parts of the thumb as an autologous bone graft followed by soft tissue coverage using a fasciocutaneous radial forearm flap, dorsal metacarpal flap, or groin flap [3,5,6]. In our opinion, osteoplastic reconstruction by taking the advantage of the amputated parts of the thumb is a perfect alternative with many advantages.…”

“…Other factors are related to the injury itself, for example, mechanism of injury, level of amputation, and time. In addition, availability of microsurgical instruments and surgeon experience play an important role in decision-making [2][3][4].…”

“…Inversely, when replantation is not feasible, multiple reconstructive techniques for proximal thumb amputation, i.e., proximal to IP joint have been established and succeeded, for example, toe-to-thumb transfer, web space deepening using flaps or skin grafts, metacarpal lengthening, pollicization, and osteoplastic reconstruction using bone grafting and flaps [ 1 - 3 ].…”

Osteoplastic Thumb Reconstruction in the Immediate Setting: A Case Series

“…With this technique, we take advantage of the "spare parts" available at the time of injury. [12][13][14][15] The bone from the amputated thumb, or from adjacent fingers in cases of multidigit injuries, is readily available to serve as autograft. When osteoplastic thumb reconstruction is performed in a delayed manner, this valuable bone would have been discarded at the time of injury with a revision amputation, thus requiring autologous bone graft harvest from an additional donor site at the time of reconstruction.…”

Neuro-Based Thumb-Tip Force and Joint Angle Modelling for Development of Prosthetic Thumb Control

“…According to clinicians, the thumb is responsible for at least 50% of overall hand functions [4]. Therefore, the function of the thumb is critical to overall hand function and is uniquely endowed with anatomical features that allow for circumduction and opposition movement [5]. The loss of the thumb will affect human daily activities as the proper hand function is limited.…”