One hundred eleven thumb amputations: replantation vs revision

R D Goldner, M P Howson, J A Nunley, R D Fitch, N R Belding, J R Urbaniak
Microsurgery 1990, 11 (3): 243-50
One hundred eleven patients who sustained isolated, complete thumb amputation between 1971 and 1985 were reviewed to assess results of replantation and to compare these with results of amputation revision. Routine postoperative evaluation was performed in 69 successful replant patients and in 42 with revision. Twenty-five of the replant group and 18 of the revision group returned for additional testing that consisted of interview and physical examination, test of activities of daily living, Jebsen test of hand function, and both static and dynamic testing on the BTE work simulator. Ninety percent of replantations were between the metacarpophalangeal (MCP) joint and the proximal third of the distal phalanx. Shortening averaged 11 mm, and range of motion was 42% +/- 28% that of the uninjured thumb. One-half of the patients could touch the MP of their ring finger, and one-fourth could touch the proximal interphalangeal (PIP) joint. Twenty-one percent had 7 mm or less two-point discrimination, and 38% had between 8 and 20 mm. Eighty percent of both groups were able to perform activities of daily living at 80% of their uninjured side. Grip strength was approximately 84% of that of the uninjured hand in each group. Lateral pinch averaged 68% +/- 26% of that of the normal side in the replant group and 91% + 9% in the amputation group. Work simulator assessment of lateral and three-point pinch was better in the revision group. Scores on Jebsen testing were slightly better for those with replanted thumbs, but in general neither replant nor revision patients functioned as well as did Jebsen's normals.(ABSTRACT TRUNCATED AT 250 WORDS)

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