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Traumatic thumb amputation: case and review.

Engdahl R, Morrison N - Eplasty (2015)

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, New York Presbyterian Hospital, The University Hospital of Cornell and Columbia, New York.

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A 28-year-old healthy right-handed man arrived at the trauma bay after motorcycle crash with a crush-avulsion amputation of his left distal thumb... In Figure 4b, levels of loss are divided into distal, middle, and proximal thirds of the thumb... Overall, amputations distal to the interphalangeal (IP) joint are often well tolerated... Heterodigital flaps, such as cross-finger flaps, or neurovascular island flaps, such as the FDMA flaps, are used for larger defects... Whereas distal amputations (distal to the IP joint) may be well tolerated without significant hand function impairment, amputations proximal to the IP joint can result in significant functional loss... Beyond the thumb IP joint, the length of the remaining digit becomes a significant factor for thumb function... The management of the loss of the distal digit (around the distal IP joint) varies from around the world... In those in whom replantation is not an option, such as our patient with a severe distal thumb crush-avulsion amputation, other reconstruction options may be considered... In this case, our patient after his acute injury underwent revision amputation with a good functional result and was not interested in further surgery (Figs 3a and 3b)... More common in Asia, a toe-to-thumb reconstruction at this level, despite its technical complexity, may be an option for select patients... Although there is currently a lack of outcomes data comparing revision amputation with distal replantation or toe-to-thumb transfer at this level, success with distal reconstructions have recently renewed interest in this area.

No MeSH data available.


Related in: MedlinePlus

Distal thumb traumatic avulsion amputation.
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Figure 1: Distal thumb traumatic avulsion amputation.

Mentions: Initial management of a patient with traumatic digit amputation consists of exclusion of life-threatening injuries and patient stabilization. The amputated part should be wrapped in moist saline gauze and placed in a waterproof plastic bag in a container with ice and water. The part should not be placed directly on ice or directly immersed in saline, as this may injure and compromise the soft tissues. With any hand amputation, factors taken into consideration include age, occupation, hand dominance, time, and mechanism of injury. When considering replantation, transfer to a facility should be done as soon as possible and ischemia time of 12 hours of warm ischemia or 24 hours of cold ischemia is often tolerated. Replanting the thumb is indicated in clean-cut injury1; however, after crush injuries, the extent of tissue damage may be severe precluding replantation.2 Our patient exhibited a severe crush injury with loss of the majority of the amputated portion that precluded replantation (Figs 1–3).


Traumatic thumb amputation: case and review.

Engdahl R, Morrison N - Eplasty (2015)

Distal thumb traumatic avulsion amputation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376099&req=5

Figure 1: Distal thumb traumatic avulsion amputation.
Mentions: Initial management of a patient with traumatic digit amputation consists of exclusion of life-threatening injuries and patient stabilization. The amputated part should be wrapped in moist saline gauze and placed in a waterproof plastic bag in a container with ice and water. The part should not be placed directly on ice or directly immersed in saline, as this may injure and compromise the soft tissues. With any hand amputation, factors taken into consideration include age, occupation, hand dominance, time, and mechanism of injury. When considering replantation, transfer to a facility should be done as soon as possible and ischemia time of 12 hours of warm ischemia or 24 hours of cold ischemia is often tolerated. Replanting the thumb is indicated in clean-cut injury1; however, after crush injuries, the extent of tissue damage may be severe precluding replantation.2 Our patient exhibited a severe crush injury with loss of the majority of the amputated portion that precluded replantation (Figs 1–3).

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, New York Presbyterian Hospital, The University Hospital of Cornell and Columbia, New York.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 28-year-old healthy right-handed man arrived at the trauma bay after motorcycle crash with a crush-avulsion amputation of his left distal thumb... In Figure 4b, levels of loss are divided into distal, middle, and proximal thirds of the thumb... Overall, amputations distal to the interphalangeal (IP) joint are often well tolerated... Heterodigital flaps, such as cross-finger flaps, or neurovascular island flaps, such as the FDMA flaps, are used for larger defects... Whereas distal amputations (distal to the IP joint) may be well tolerated without significant hand function impairment, amputations proximal to the IP joint can result in significant functional loss... Beyond the thumb IP joint, the length of the remaining digit becomes a significant factor for thumb function... The management of the loss of the distal digit (around the distal IP joint) varies from around the world... In those in whom replantation is not an option, such as our patient with a severe distal thumb crush-avulsion amputation, other reconstruction options may be considered... In this case, our patient after his acute injury underwent revision amputation with a good functional result and was not interested in further surgery (Figs 3a and 3b)... More common in Asia, a toe-to-thumb reconstruction at this level, despite its technical complexity, may be an option for select patients... Although there is currently a lack of outcomes data comparing revision amputation with distal replantation or toe-to-thumb transfer at this level, success with distal reconstructions have recently renewed interest in this area.

No MeSH data available.


Related in: MedlinePlus