Twenty-five cases of avulsive amputation of the thumb are reported. Twenty-one of the 25 cases were categorized as Grade I avulsions (little or no skin defect) and four were categorized as Grade II avulsions complicated by a large skin defect. Three different replantation techniques were used and compared: (1) direct vessel anastomosis, (2) arterial after artery transfer from other digits. The authors concluded that direct vessel anastomosis was not the preferred method and that technique 2 could be used in any case but was especially suited to Grade II reconstructions. Technique 3 is mainly used in Grade I avulsions. anastomosis between the superficial branch of the radial ar-0 1996 Wiley-Liss, Inc tery and distal end of the thumb, and (3) arterial anastomosis MICROSURGERY 17~17-20 1996
Avulsive amputation of the thumb is a serious trauma endangering bone, tendon, nerve and vessels. At the beginning of replantation surgery, avulsion injury was regarded as a contraindication for replantation because of the severe damage to the vessels. As microsurgical techniques became more refined, replantation of avulsion amputations proved possible but optimal management still remains controversial. Our report compares the replantation techniques of direct arterial anastomosis, anastomosis between the distal artery and the superficial branch of the radial artery, and arterial anastomosis after artery transfer.
Methods
This group of cases consists of consecutive patients entering the Department of Orthopaedic Surgery in Jinan Military General Hospital. Patients whose avulsed thumbs were not successfully revascularized upon leaving the operating room were excluded from the study. Only patients whose thumbs were evaluated and vascularized when they entered the ICU after surgery were included.
Thumb avulsion injuries were classified into two grades. If the thumb was injured with little or no skin defect it was considered Grade I (Figs. 1,2). When the avulsion was complicated by a large defect of the dorsal hand skin, it was considered Grade I1 (Fig. 3).
Preoperative management included assessment of blood loss, monitoring of blood pressure and pulse, and in some cases, anti-shock treatment including blood transfusion. For