[Late results of replantations in tip amputations of the thumb].
OBJECTIVE
We retrospectively evaluated replantations performed for Tamai type 1 thumb amputations.


METHODS
The study included 14 patients (12 males, 2 females; mean age 28 years; range 14 to 40 years) whose replanted thumbs survived following replantation for Tamai type 1 amputations in the distal nail fold of the thumb. Central digital artery anastomosis was performed in all the cases. Four patients with an appropriate vein had a single volar vein anastomosis. Nerve repair could be possible in only three patients. Sensory evaluations were made with the Semmes-Weinstein monofilament test, static and moving two-point discrimination tests, and vibration test. In addition, patients were evaluated with respect to atrophy in the replanted part, nail-bed deformities, and cold intolerance. The mean follow-up period was 11 months (range 6 to 48 months).


RESULTS
The Semmes-Weinstein test was green (range 2.83 to 3.22) in five patients (35.7%), blue (range 3.22 to 3.61) in eight patients (57.1%), and purple (range 3.84 to 4.31) in one patient (7.1%). The mean static and moving two-point discrimination test results were 6.9 mm (range 3 to 10 mm) and 4.5 mm (range 3 to 6 mm), respectively. Compared to the intact fingers, vibration was increased in six thumbs (42.9%), decreased in six thumbs, and the same in two thumbs (14.3%). Atrophy of the replanted parts was observed in five patients (35.7%). Three patients (21.4%) complained about cold intolerance, and three patients had nail-bed deformities. The mean time to return to work was 3.2 months (range 2 to 6 months).


CONCLUSIONS
Despite technical difficulties, thumb replantations yield good functional and aesthetic results. Sensory recovery is sufficient even after tip replantations without nerve repair.
Ozçelik
Ismail Bülent
IB
IST-EL Hand Surgery, Microsurgery and Rehabilitation Group, Istanbul, Turkey. bulent-ozcelik@hotmail.com
Purisa
Hüsrev
H
Mersa
Berkan
B
Sezer
Ilker
I
Ertürer
Erden
E
Ergün
Ozge
O
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D012677:Sensation; D013933:Thumb / Q000098:blood supply* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult