Thumb Amputation Research Articles

Partial hand and finger amputations in Sweden: an observational study of 6918 patients

BackgroundWe aimed to use open source data to understand the incidence, trends, and regional differences of finger and partial hand amputations on a national level in individuals aged 15 or older in Sweden.MethodsWe analyzed 6,918 patients aged 15 and older who had experienced finger and partial hand amputations. Incidence rates, trends, and regional disparities were assessed using negative binomial regression models and Student’s t-tests. Future trend prediction was performed using Poisson regression.ResultsFinger amputations declined most, followed by partial hand and thumb amputations. Regional variations existed, with Stockholm having the lowest and Gotland highest incidence respectively. Overall, the incidence of finger, thumb and partial hand amputations in Sweden decreased slightly. Future trend analysis indicated decreasing incidence.ConclusionAlthough, lacking in definition, publicly available data can be used for monitoring of finger, thumb, and partial hand amputation incidence on a national level. Sex, age, and regional differences were observed, suggesting the need for targeted interventions to address disparities and mitigate the burden of finger and partial hand amputations on affected individuals.

Second Toe-to-thumb Transfer Using Intramedullary Screw Fixation after Traumatic Thumb Amputation.

Loss of the thumb secondary to trauma leads to significant disability due to the digit contributing 40% of overall hand function. Toe-to-thumb transfer has been a well-studied reconstructive method as a means to restore function after thumb amputation. First described in 1969 by Cobbett and colleagues, toe-to-thumb transfers have undergone several modifications in technique to better improve functional and aesthetic outcomes, including toe wrap-around flaps, trimmed great toe transfer, and second toe transfers. Although these methods have allowed patients to retain use of the thumb, traditional interosseous wire reattachment often leads to significant stiffness and need for prolonged rehabilitation to regain maximal function. Intramedullary screw fixation has been increasingly used in phalanx and metacarpal fractures, but its implementation outside of these contexts is not well reported. Here, we present a case of a patient who presented with traumatic thumb amputation and was treated with second toe-to-thumb transfer with intramedullary screw fixation, a novel mode of interosseous rigid fixation in toe-to-hand surgery. Postoperatively, our patient was able to begin mobilizing the new thumb immediately, which allowed for earlier return to work. We believe our technique can be applied to other cases of second toe, as well as great toe, transfers to improve length of recovery and rehabilitation postoperatively.

Osteoplastic Reconstruction of the Thumb: a case report

Background & Objectives: Thumb accounts for 50% of the hand function. Amputation of the thumb severely jeopardises the hand function. Thumb replantation, toe transfer are the ideal methods for restoring the hand function, but is not always possible owing to type of injury, time to presentation, surgical skill and set up. Osteoplastic thumb reconstruction for amputation around the metacarpophalangeal joint is a good treatment option to restore the hand in a developing setup. Presentation of Case: A 25 yrs male with amputation of thumb around metacarpophalangeal joint with delayed presentation and crushing component of distal part underwent multiple staged osteoplastic reconstruction of the thumb. The procedures consisted of bony structure fixation with bone graft followed by coverage with a thinned tubed groin flap which was divided at 2 weeks interval. The thumb was made sensate with sensate flap (first dorsal metacarpal artery flap). Discussion: Thumb replantation is ideal in acute setup in a clean traumatic amputation, while toe transfer is ideal in a delayed setup with healed wound. This requires a good operating room set up with microsurgical set up and skilled manpower, which is difficult in a developing country. Osteoplastic reconstruction requires multiple staged procedures that can be done at a primary level setup. Conclusion: Osteoplastic thumb recontruction is a good option for amputation around the metacarpophalangeal joint to restore hand function in a resource limited set up.

Successful reimplantation and nerve catheter analgesia in a pediatric thumb amputation case

Successful reimplantation and nerve catheter analgesia in a pediatric thumb amputation case

REPLANTATION OF THE THUMB OR REVISION OF AMPUTATION: AN EPIDEMIOLOGICAL STUDY.

This article presents a retrospective cohort study analyzing patients from IOT-FMUSP who underwent replantation or revision amputation procedures for traumatic thumb amputation between 2013 and 2020. The study included 40 patients in the replanted group and 41 patients in the amputed group. The patients were divided according to the level of amputation and their medical records were analyzed. A total of 81 patients with digital amputation were analyzed, consisting of 79 males and 2 females, with mean ages of 43 and 49 for the amputed and replanted groups, respectively. According to the Biemer classification, 28.4% had proximal amputation, while 71.6% had distal amputation. The most common occupation was bricklayer (19.75%), and 80.24% were manual workers. Of the patients, 65% returned to their previous work, with 77.77% of them having amputation on their non-dominant hand, mostly caused by circular saw accidents (77.77%). The replantation success rate was 78%, with an average ischemia time of 9 hours and door-to-room time of 2 hours. the study findings revealed that traumatic thumb amputation predominantly affects working-age males with a low education level and the success rate of replantation was high in this ischemia time and door-to-room conditions. Level of Evidence II, Retrospective study.

Immediate Reconstruction of Distal Thumb Amputations Using Reverse Homodigital Dorsoradial Flap and the Amputated Part of the Phalanx

Immediate Reconstruction of Distal Thumb Amputations Using Reverse Homodigital Dorsoradial Flap and the Amputated Part of the Phalanx

Retrospective chart review suggests patients referred to therapy following digit and partial thumb amputations have decreased pain and improved function

Retrospective chart review suggests patients referred to therapy following digit and partial thumb amputations have decreased pain and improved function

A biomechanical study of osseointegrated patient-matched additively manufactured implant for treatment of thumb amputees.

Thumb amputations leads to 50 % loss in hand functionality. To date, silicone vacuum prosthesis and autologous transplantation are the most adopted treatment solutions: nevertheless, vacuum prostheses lack in stability and cause skin issue and surgical treatment is not always accepted by patients. Osseointegrated implants were demonstrated to enhance stability, restore osseoperception and increase the time of prosthesis use. Thumb amputations present varying stump sizes: a standard size implant cannot address specificity of each patient, while a patient matched solution can meet surgeon requirements, by geometrical features of implant. The fixture presented in the current paper is the first additively manufactured patient matched osseointegrated implant for the treatment of thumb amputees. The current work aims to verify and validate a predictive finite element model (FEM) for mechanical strength of the presented fixture. FEM was demonstrated to correctly evaluate the mechanical strength of patient matched device. Minimum strength requirements were calculated in different core diameters: FEM were experimentally validated. Safety factor of 1.5 was guaranteed. Finally, considerations on performance of the prototype were carried out by means of insertion tests in Sawbones and axial pull-out force assessment. Cadaver tests to evaluate the entire procedure and production process are ongoing.

Qualitative needs assessment for the development of a smart thumb prosthesis

Purpose To critically explore experiences following thumb amputation and delineate elements of an ideal thumb prosthesis from the end user perspective. Methods A qualitative study was undertaken with end user stakeholder groups, which included persons with a thumb amputation, rehabilitation professionals, and prosthetists. Analysis proceeded in line with conventional content analysis. Results Six patients with traumatic thumb amputation and eight healthcare providers (HCPs) were interviewed. Six themes were identified. The first theme discussed the impact of losing a thumb upon function, occupational activities, and mental wellbeing. The second theme reflected the idiosyncratic nature of thumb amputees, including their goals and nature of injury. The third theme stressed the costs associated with obtaining a thumb prosthesis. The fourth theme explored patient frustration and causes of device abandonment. Theme five summarized opinions on currently available thumb prostheses, and theme seven was the ideal design for a thumb prosthetic, including sensory elements and materials. Conclusions Representative data from stakeholders mapped the current status of thumb prostheses. Preferences for an ideal thumb prosthesis included a simple, durable design with the ability to oppose, grasp, and sense pressure. Affordable cost and ease of fit emerged as systemic objectives.

Two Thumbs Down: A 10-Year Analysis of Crossbow-Related Hand and Digit Injuries in the United States.

Modern crossbow is a popular weapon used throughout the United States for outdoor recreation. Crossbow mechanics place the hand and digits at significant risk of injury while shooting or handling these weapons; however, injury patterns have been poorly documented. In this study, the authors use a national database to assess patterns of crossbow-related injuries of the hand and digits. A retrospective review of the National Electronic Injury Surveillance System database was conducted to identify crossbow-related hand and digit injuries over the past 10 years. Demographic data, injury timing, anatomical injury location, specific injury diagnosis, and disposition data were collected. A total of 15 460 crossbow-related hand injuries were identified between 2011 and 2021. A strong temporal relationship was identified, with 89% of injuries occurring between the months of August and December. Male patients sustained most injuries (>85%). Body areas injured were the digits (93.2%) and the hand (5.7%). The most common injuries were laceration (n = 7520, 48.6%), fracture (n = 4442, 28.7%), amputation (n = 1341, 8.7%), and contusion/abrasion (n = 957, 6.2%). More than 50% of cases involved injury to the thumb, with approximately 750 thumb amputations recorded during the time period examined. This study is the first to document the patterns of hand and digit injuries associated with crossbow use on a national scale. These findings have important implications for public health awareness campaigns targeting hunters and support the designation of crossbow "safety wings" as a mandatory feature of crossbow design.

Suture of severed hand at Binh Dinh Provincial General Hospital: A case report

Hands play such an essential role in our lives. Damage to any one of the mechanisms of the hand, such as the tendons, ligaments, or the joints between the bones, can severely hamper someone’s lifestyle and infringe on their career. Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation, a completely amputated hand by vascular anastomosis technique, was successfully performed [1]. Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by S.T. Komatsu, et al. (1968) [2]. The foundation of microsurgery gives the successful anastomosis of 1 mm - blood vessel and replantation of amputated extremity. In this article, the authors presented a case report of a 39-year-old male patient with a completely amputated left hand at the level of the wrist joint which was managed by replantation in Binh Dinh Provincial General Hospital to reattach his hand successfully with a good functional outcome.

ПРИМЕНЕНИЕ АУТОВЕНОЗНОЙ ПЛАСТИКИ ПРИ РЕПЛАНТАЦИИ БОЛЬШОГО ПАЛЬЦА КИСТИ

The study aims to evaluate the effectiveness of autovenous plasty for thumb replantation. From 2014 to 2021, the Republican Scientific Center for Cardiovascular Surgery (Dushanbe) performed 18 thumb replantations and revascularizations, with 8 (44.4%) patients having complete traumatic thumb amputation and one patient undergoing replantation using autovenous plasty for primary fusion of the metacarpophalangeal joint. After the surgical interventions, 94.4% of patients showed positive results, including 7 patients (39%) with completely engrafted replanted parts preserving thumb function, whereas one patient (5.6%) demonstrated signs of ischemia of the replanted part of the thumb. Thus, in the case of crushed and avulsion traumatic amputations with damaged anatomical structure of a large part of the vascular-nervous bundle and virtually no chances for successful replantation, radial digital autovenous plasty allows expanding the indications for thumb eplantation, which is critical for the hand function.

General Population and Surgeon Preferences for Pollicization Versus Toe-To-Thumb Transfer for Reconstruction of Traumatic Thumb Loss in Adults: An International, Multi-Center Survey Study

Data objectively comparing outcomes following pollicization versus toe-to-thumb transfer for reconstruction after traumatic thumb amputation in adults remains sparse. Given that this decision is reliant on personal preference, it is important to understand the subjective nature of these preferences, particularly in the context of culture. The purpose of this study was to compare Eastern and Western societal and hand surgeon preferences for pollicization versus toe-to-thumb transfer for traumatic thumb reconstruction. Investigators from 6 international locations recruited local hand surgeons and members of the general population. Austria, Germany, the United States, and Spain were grouped as "Western" nations. China and India separately represented "Eastern" nations. Participants completed a questionnaire evaluating their personal preferences for pollicization and toe-to-thumb transfer. The questions posed to the general population and hand surgeons were identical. Demographic data were also collected. When comparing the Western nations, China, and India, there was no difference in personal preferences within the general population for pollicization versus toe-to-thumb transfer. In contrast, most Indian hand surgeons favored toe-to-thumb transfer and most Western surgeons were uncertain about which procedure they would favor. Surgeons had more optimistic expectations regarding postoperative hand function, new thumb sensation, and hand appearance following pollicization than the general population. Similarly, for toe-to-thumb transfer, a greater proportion of surgeons predicted good-to-excellent function, sensation, and appearance. There was no clear, observed "East" versus "West" difference in the general population's personal preferences for pollicization versus toe-to-thumb transfer among study participants. The members of the general population and hand surgeons had different outcome expectations. Understanding how culture influences patient and hand surgeon preferences for pollicization versus toe-to-thumb transfer may help guide future decision-making for traumatic thumb reconstruction.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Great Toe Transplantation.

Despite being relatively uncommon in the general population, thumb amputations cause severe disability. More than 3,300 thumb amputations occurred in the United States. The thumb makes up around 40% of the function of the hand. Therefore, losing it would result in significant medical, hospital, and societal costs. Thumb reconstruction surgery's primary goal is to restore grip strength, including the range of motion, fine and tripod pinch, power grasp, strength, and sensibility, while secondary goals include restoring hand aesthetics. In cases of thumb replantation, like-for-like replacement is possible; however, when thumb replantation is not possible, great toe-to-hand transplantation is the best available reconstruction. When compared with other reconstructive options such as osteoplastic thumb reconstruction, pollicization, second toe transplantation, and the use of a thumb prosthesis, great toe transplantation provides superior function and aesthetics. For restoring pinch, sensitivity, strength, and aesthetics of the hand with well-tolerated donor site morbidity, toe to thumb transplantation is regarded as the gold standard.

Reverse homodigital dorsal wraparound flap for reconstruction of distal thumb

Reconstruction of degloving injury or amputation of distal thumb with no indication of replantation has always been a challenging problem for hand surgeons. In this study, a reverse homodigital dorsal wraparound flap innervated by the dorsal digital nerve was devised to repair degloving injury or amputation of distal thumb in 20 consecutive cases. In nine cases of thumb amputation, we skeletonized the phalanxes of the amputated part as a free cortical bone with Kirschner wires. All flaps survived uneventfully. The radiographs showed bone healing in all the patients of thumb amputation within 6 weeks postoperatively. At final follow-up, the appearance of the reconstructed thumb was acceptable and flap sensation and range of joint motion were satisfactory. This flap is a simple and reliable alternative method for degloving injury or amputation of distal thumb when replantation is impossible and patients refuse to donate tissues from toes. Type of study/level of evidence Therapeutic IV.

Osteoplastic Thumb Reconstruction in the Immediate Setting: A Case Series.

Background:Traumatic thumb amputation can have devastating effects on residual hand function. When replantation is not possible, thumb reconstruction is often performed in a delayed manner and may require multiple stages. Furthermore, reconstruction techniques often require microsurgical skills and equipment, which are not readily available at all institutions. This case series illustrates our technique for immediate osteoplastic thumb reconstruction following traumatic amputation.Methods:This is a case series involving all patients who sustained unreplantable thumb amputations and underwent immediate osteoplastic thumb reconstruction with bone autograft and pedicled groin flap by the senior author from September 2016 through August 2018.Results:Five patients underwent immediate osteoplastic thumb reconstruction during the study period. Total operative time for the initial osteoplastic reconstruction averaged 158 minutes (range 96–290 minutes). In addition to flap division surgery, patients underwent an average of 1.2 revision procedures (range 0–2), primarily for debulking and hardware removal. Patients achieved an average gain in length of 3.3 cm compared with the maximum anticipated length with revision amputation at the time of injury, and had stable clinical outcomes for a minimum of 12 months.Conclusions:Osteoplastic thumb reconstruction is a useful technique for thumb reconstruction for select patients following traumatic thumb amputation. Advantages of this approach include shorter overall operative times and hospital length of stay, minimal donor site morbidity, and a straightforward, reproducible technique.

First dorsal interosseous muscle transfer to restore opposition of the new thumb after index pollicization: anatomical description of an original technique and case report

Index pollicization in severe thumb hypoplasia or aplasia in children or for the reconstruction of a mutilated thumb in adults is a rare and technically demanding procedure. Weakness of the new thumb is routinely reported after index pollicization. An inappropriate position of the first dorsal interosseous muscle (FDIM) can partly explain this strength deficit. Here, we report an original anatomical study on FDIM transfer for reanimation of the new thumb’s opposition function and its clinical application. An anatomical study was carried out on three upper limbs from fresh, non-embalmed adult cadavers. We demonstrated the feasibility of an FDIM transfer pedicled on the proper FDIM artery and the deep branch of the ulnar nerve. The proximal FDIM insertions were sutured to the lateral border of the flexor retinaculum to recreate the superficial thenar musculature. This procedure was performed on a 52-year-old man who was referred to us with swelling on his hand. We discovered a myxoid inflammatory fibroblastic sarcoma of the thumb that required proximal thumb amputation while preserving the base of the first metacarpal. To our knowledge, this is the first description of FDIM pedicled flap transfer during an index pollicization procedure among an adult population. However, in severe thumb hypoplasia or aplasia cases, this procedure is limited by the size and anatomical variations of the neurovascular structures among a population affected by radial longitudinal deficiency.

FUNCTIONAL RESTORATION OF THE PARTIAL HAND AMPUTEE USING DIGITAL DISTRACTION LENGTHENING. A CASE SERIES STUDY.

FUNCTIONAL RESTORATION OF THE PARTIAL HAND AMPUTEE USING DIGITAL DISTRACTION LENGTHENING. A CASE SERIES STUDY.

User experiences of digital prostheses in daily functioning in people with an amputation of thumb or finger

Study Design"Qualitative research design using interpretative phenomenological analysis (IPA) to interpret users’ experiences with digital prostheses. BackgroundDigital prostheses are rarely used, and little is known about the experiences of traumatic finger amputees with digital prostheses. When advising patients regarding digital prostheses, it is crucial for professionals to understand users experiences of wearing a digital prosthesis and the meaning attached to wearing a digital prosthesis. Purpose of studyThe aim of this study was to explore and understand users experiences of wearing a digital prostheses in daily functioning. MethodsIndividual semi-structured interviews were conducted, recorded, and transcribed. The written interview texts were analysed following Interpretative phenomenological analysis guidelines. ResultsFour participants were interviewed. They experienced the prostheses as valuable additions to their daily functioning. Three different themes relating to wearing and using digital prostheses emerged from in-depth analysis of the data: How the prosthesis supporting them regaining a ‘grip’ on life, reduced overload on unaffected side and restored body image. ConclusionsThis study provides a deeper understanding of the experiences of people with digital amputations who use prostheses. Most importantly, that a prosthesis is of crucial importance for participants to be able to act independently and autonomously as well as to participate in family, work and social environments. This insight will help practitioners when considering, with clients the most appropriate digital prosthesis to meet their goals.