[Thumb reconstruction in emergency, not including replantation].
Many articles have discussed secondary thumb reconstruction but only few have been devoted to acute reconstruction. We propose to artificially separate four circumstances: (i) the thumb is preservable without associated trauma of the fingers. The rule is not to burn the bridge of secondary reconstruction; (ii) the thumb is preservable but a neighboring finger is seriously injured and functionally condemned. The finger has to be used as a "bank" to borrow the necessary anatomical structures for reconstruction of the thumb; (iii) the thumb is not preservable and the lesions of a neighboring finger allow to use it for a pollicization. The difficult decision is between the immediate transposition or maintenance for secondary pollicization. Only finger devascularization is a clear indication for acute pollicization; (iv) Finally when the thumb is not preservable and there is no associate finger injury, it is difficult to assess and inform sufficiently the patient to take a decision. Secondary thumb reconstruction is the best choice.
Foucher
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D000673:Amputation, Traumatic / Q000601:surgery*; D004630:Emergencies; D016267:External Fixators; D006801:Humans; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D013933:Thumb / Q000293:injuries* / Q000601:surgery*