Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation
Thumb reconstruction has always been challenging for hand surgeons. The disability can severely influence the working and social life of the patient, even if just the distal phalanx is affected. Revascularization is the best surgical option for incomplete distal amputation, although microsurgical re...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2021-07-01
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| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2019.1672840 |
| _version_ | 1827817343040880640 |
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| author | L Losco J Kaciulyte G Delia A Bolletta Federico Lo Torto G Di Taranto D Ribuffo E Cigna |
| author_facet | L Losco J Kaciulyte G Delia A Bolletta Federico Lo Torto G Di Taranto D Ribuffo E Cigna |
| author_sort | L Losco |
| collection | DOAJ |
| description | Thumb reconstruction has always been challenging for hand surgeons. The disability can severely influence the working and social life of the patient, even if just the distal phalanx is affected. Revascularization is the best surgical option for incomplete distal amputation, although microsurgical reconstruction, sometimes, could be not feasible. A simple basic-skills-based reconstructive method, that takes into account the length preservation and a short recovery should be advocated. We treated 14 incomplete distal thumb amputations with bone exposure, classified as Hirase zone IIA-IIB. The distal thumb was held by a short tissue islet, nor neurovascular bundle, nor dorsal vein was included. Patients were assessed for skin and bone healing, length of thumb shortening, and time of return to full occupational activity. QDASH score was evaluated along with a two-point discrimination test. The outcome was fair in all 14 patients. Partial distal thumb necrosis was observed in six cases (40%); they healed by secondary intention. Finger shortening had a mean of 6.9 mm (range, 6–8 mm), mean interphalangeal joint motion was 48 degrees (range,45–55 degrees). The median static two-point discrimination was 7.1 mm (range, 6–9 mm), the mean quick DASH score was 1.8 (range, 0–4.5). All patients returned to work within a mean of 4.3 weeks (range, 4–5 weeks). The follow-up period was 12 months. Length preservation, fast recovery and easy return to manual work, above all, are the keystones of our successful procedure. Whether the revascularization is not executable, we provide a reliable and simple method to grant a functional thumb. |
| first_indexed | 2024-03-12T00:32:58Z |
| format | Article |
| id | doaj.art-464d06eee2e04a34970a58aff0d0e12f |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:32:58Z |
| publishDate | 2021-07-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-464d06eee2e04a34970a58aff0d0e12f2023-09-15T10:07:31ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532021-07-0134659560010.1080/08941939.2019.16728401672840Back to basics with distal thumb reconstruction. Easy management of the incomplete amputationL Losco0J Kaciulyte1G Delia2A Bolletta3Federico Lo Torto4G Di Taranto5D Ribuffo6E Cigna7Dipartimento di Ricerca Traslazionale e Delle Nuove Tecnologie in Medicina e Chirurgia, Università Degli Studi di PisaDepartment of Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Chief: Prof. Diego Ribuffo, Sapienza University of Rome, Policlinico Umberto IDipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva “G. Barresi”, Università Degli Studi di MessinaDepartment of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of SassariDepartment of Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Chief: Prof. Diego Ribuffo, Sapienza University of Rome, Policlinico Umberto IDepartment of Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Chief: Prof. Diego Ribuffo, Sapienza University of Rome, Policlinico Umberto IDepartment of Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Chief: Prof. Diego Ribuffo, Sapienza University of Rome, Policlinico Umberto IDipartimento di Ricerca Traslazionale e Delle Nuove Tecnologie in Medicina e Chirurgia, Università Degli Studi di PisaThumb reconstruction has always been challenging for hand surgeons. The disability can severely influence the working and social life of the patient, even if just the distal phalanx is affected. Revascularization is the best surgical option for incomplete distal amputation, although microsurgical reconstruction, sometimes, could be not feasible. A simple basic-skills-based reconstructive method, that takes into account the length preservation and a short recovery should be advocated. We treated 14 incomplete distal thumb amputations with bone exposure, classified as Hirase zone IIA-IIB. The distal thumb was held by a short tissue islet, nor neurovascular bundle, nor dorsal vein was included. Patients were assessed for skin and bone healing, length of thumb shortening, and time of return to full occupational activity. QDASH score was evaluated along with a two-point discrimination test. The outcome was fair in all 14 patients. Partial distal thumb necrosis was observed in six cases (40%); they healed by secondary intention. Finger shortening had a mean of 6.9 mm (range, 6–8 mm), mean interphalangeal joint motion was 48 degrees (range,45–55 degrees). The median static two-point discrimination was 7.1 mm (range, 6–9 mm), the mean quick DASH score was 1.8 (range, 0–4.5). All patients returned to work within a mean of 4.3 weeks (range, 4–5 weeks). The follow-up period was 12 months. Length preservation, fast recovery and easy return to manual work, above all, are the keystones of our successful procedure. Whether the revascularization is not executable, we provide a reliable and simple method to grant a functional thumb.http://dx.doi.org/10.1080/08941939.2019.1672840fingertipincomplete thumb amputationthumbthumb amputationthumb reconstructionhand trauma |
| spellingShingle | L Losco J Kaciulyte G Delia A Bolletta Federico Lo Torto G Di Taranto D Ribuffo E Cigna Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation Journal of Investigative Surgery fingertip incomplete thumb amputation thumb thumb amputation thumb reconstruction hand trauma |
| title | Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation |
| title_full | Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation |
| title_fullStr | Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation |
| title_full_unstemmed | Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation |
| title_short | Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation |
| title_sort | back to basics with distal thumb reconstruction easy management of the incomplete amputation |
| topic | fingertip incomplete thumb amputation thumb thumb amputation thumb reconstruction hand trauma |
| url | http://dx.doi.org/10.1080/08941939.2019.1672840 |
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