Successful replantation after avulsion amputation of the thumb

Abstract

Introduction Degloving injuries to the fingers, especially the thumb, present a significant challenge for reconstructive surgeons. Several classifications have been proposed to assess the extent of injury. Latest approach is now that microsurgical repair is the method of choice in all types of ischemic injuries, including type III ring avulsion.

Case outline We present a case of a successful microvascular replantation of the thumb amputated by an avulsion mechanism caused by a drill in the 19-year-old male. The thumb was almost completely degloved about 2 cm distal to the metacarpophalangeal joint. According to the Urbaniak classification, it was a type III degree of injury (Kay type IV). Surgery was performed three hours after the injury. The ulnar digital artery was anastomosed end-to-end. Two dorsal veins were drained and anastomosed. After six months, the appearance of the replanted finger was aesthetically pleasing. The patient was followed up again 30 months after surgery. Grip strength measured with Jamar’s dynamometer is 5% less compared to the uninjured hand. According to the total arc of motion scale, almost full range of motion was obtained in the metacarpophalangeal joint with full opposition and good grip. According to the Medical Research Council scale, the sensitive recovery has reached S3. The disabilities of the arm, shoulder and hand score is 0 point. This represents a complete and unlimited function even though the thumb is contracted in the interphalangeal joint.

Conclusion The patient returned to his previous workplace and he remains satisfied with the function of the replanted thumb for daily and work activities.

Keywords: avulsion amputation; replantation; hand