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PubMedDate not supplied

[Reconstructive surgery of the thumb after traumatic amputation (author's transl)].

The authors analysed the results of two series of patients treated either by lengthening (16 cases) or digital pollicization (45 cases). The conclusions about the indications for the two techniques are as follows: When the amputation is proximal and the sole lesion, pollicization of the ring finger is preferred. In distal amputations in children, pollicization is still indicated, but in adults, lengthening, with a pedicle island-flap to give sensation is preferable. In amputations of the thumb associated with lesions of other digits, pollicization is not feasible; in these cases, the authors recommend a toe transplant using micro-surgical technique.

Adolescent↗
PubMed1991

Per Primam thumb replantation for all patients with traumatic amputations.

Forty-two complete thumb replantations performed between 1980 and 1984 were reviewed. The mean follow-up time was 14 months. Replantation was attempted for all thumb amputations regardless of mechanism or severity of injury. Sixteen (38%) failed intraoperatively or postoperatively. Thumbs with narrow zones of injury showed a significantly higher survival rate than those with wide zones of injury. Eighty percent of those with poor arterial flow intraoperatively ultimately failed, despite pharmacologic treatment and multiple vein-graft anastomoses. Two thumbs with no vein repairs ultimately survived. Reexploration for loss of perfusion succeeded in 60% of cases. Total metacarpophalangeal and proximal interphalangeal active motion postoperatively averaged 68 degrees. Median static two-point discrimination returned to 11 mm. Avulsed thumbs survived in 46% of cases. Replantation should be attempted in all cases of thumb amputation, as success cannot be predicted by mechanism or severity of injury. Thumbs with poor intraoperative flow (20%) or no venous return (50%) can survive and should not be primarily amputated. Vein grafting is not mandatory if shortening allows anastomoses to be tension free. Prompt reexploration of acute vascular occlusions is worthwhile.

Adult↗
PubMed1978

[Reconstructive microsurgery in traumatic amputations of wrist and fingers (authors transl)].

A specialised department for vascular microsurgery was established in the Research Institute for Clinical and Experimental Surgery in 1973. 58 replantations of fingers in 42 patients were made. Total percentage of healing was 52 (30 fingers). Doppler's flowmetry is very useful for the control of microanastomoses of the arteries in fingers. Reconstruction of vessels in fingers was made with an operative microscope (magnification 16--24 times), special microtechnique and 10/0 sutures. Successful replantation is possible even 10--12 hours after severance, it the finger is kept in hypothermia at + 4 degrees C. Rapid admission of the patients to the hospital, i.e. improved information and emergency transport may shorten ischaemic time. The first stage of replantation is the marking of arteries and veins in the finger and in the stump. It is essential to suture not less than 2--3 veins for one artery and nerve. Thorough rehabilitation is of utmost importance to get the best functional results.

Amputation, Traumatic↗
PubMed1988

[Subtotal traumatic amputation of the limb in young children. Analysis of 2 successful repairs].

Two replantations of nearly completely amputated limbs are presented. In both cases there were young children. These two success explain the necessity of limb preservation if the nerve integrity is respected. In the young child, the vital risk is lower because of the vessels, the local immunologic defense. The bone union is normal. The vascular suture with venous grafts is made with simple interrupted sutures rather than with continuous over and over sutures. The fasciotomy avoid a compartment syndrome. The bone graft growth is unforeseeable. These two case reports are nearly experimental because of the young age of the patients.

Age Factors↗
PubMed1988

[Lengthening middle hand and finger segment stumps by external distraction devices following traumatic amputations and in congenital abnormalities].

Since November 1984, lengthening of metacarpals and digital phalanges by a distraction apparatus has been performed in six metacarpal bones and four phalangeal bones in nine patients (four females, five males). The age ranged from 14 to 59 years (average 36). The follow-up period was from two to 28 months (average 16). Lengthening was performed by two kinds of external distraction devices, the Ikuta external fixateur for metacarpals and the mini-Hoffmann-device for phalanges. The achieved elongation of the metacarpal bones varied from 26 mm to 30 mm (average 28.8 mm), and of the digital phalanges from 10 mm to 17 mm (average 13.5 mm). During the operation, the bone was distracted primarily about 5 mm and thereafter it was gradually distracted at a rate of 0.5 to 1 mm per day. Blood supply and subjective complaints were examined carefully. During distraction, following complications were observed: Fracture of grafted bone, necrosis of free grafted skin, rupture of a tendon with neglected lesion and delayed spontaneous bone union between the fragments. It is emphasized that skin, tendons, and other soft tissues around the thumb and fingers to be elongated should be intact and that the gap should be filled with an en-bloc bone graft. This facilitates early union in spite of a relatively short period of immobilization. Because of the relative simplicity of the method, no microsurgical technique is required. The main advantage of the procedure is that the lengthened digit retains its original sensation, vascular supply and some mobility. It is a useful procedure especially when a patient does not want to sacrifice another digit.

Adolescent↗
PubMedDate not supplied

Traumatic amputation.

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Amputation, Traumatic↗