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The thumb
is the most important finger on the
hand, accounting for at least 40% of
function by some estimates. Loss
of function with thumb amputation can be
devastating, and replantation is
therefore more broadly indicated.
This
patient suffered a hand saw
injury. The thumb was amputated at
the proximal phalanx, with the proximal
stump fairly cleanly cut.
 On
closer inspection, the thumb had
multi-level injury. The part had
actually been trapped in the saw
mechanism and guard before being ejected
under high speed. There was also
some shredding of the proximal soft
tissue.
 Bone
shortening was required in order to
debride all clearly devitalized
tissue. Damaged tissue can promote
thrombosis and lead to finger loss,
therefore as much as possible is
removed. The bones were shortened
to flat surfaces an the reduction was
maintained with k-wires. The
basilar thumb joint was left free for
early motion.
The patient
is pictured below about a year after
injury. Note the appearance of the
thumb and thumb function are excellent.
In a side
by side comparison of the replanted
finger on the left and the normal thumb,
the replanted finger is slightly shorter
and smaller.
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