Article
Avoiding vein grafts for arterial repair in avulsion amputations of thumb – Case series
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Published: | February 6, 2020 |
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Objectives/Interrogation: The first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu in 1968. Avulsion amputations of the thumb at the level of metacarpophalangeal joints pose a tedious task for direct arterial repair, even with adequate bone shortening. Owing to the short length of princeps pollicis from the deep arch, tight working space in the first web under microscope and the associated intimal injuries, we advise transposing the radial indices artery in such cases which gives adequate length and non-injured artery for a tension free repair.
Methods: Four cases with avulsion amputations at the level of thumb metacarpophalangeal joint were followed up for a period of 11 to 14 months.
Results: All four were avulsion type of amputations with one occurring in a female due to rodeo type injury where the thumb was avulsed while playing a tug of war game. All four cases of avulsed thumbs survived and were followed up for a period of 12 months. K wires were removed at 5 weeks and put on physiotherapy. All patients regained a useful protective sensation with 2 point discrimination of 7 to 9 mm, with good range of movements and were able to oppose the thumb to little finger.
Conclusion: In Avulsion amputations of thumb using this method of transposing radial indices artery avoids the tedious task of vein grafts for arterial repair, reducing the operating time and improving successful outcomes in thumb reimplantations.