title: Composite grafting of a distal thumb amputation: a case report and review of literature.
abstract: OBJECTIVE
  We report a case in which an avulsion-amputation of the thumb proximal to the lunula was repaired by reattaching the amputated segment as a composite graft. The graft demonstrated complete survival with only a minimal sacrifice in length.
  
  
  METHODS
  A 23-year-old man presented 4 hours after an avulsion injury of the thumb with associated distal and proximal phalanx fractures. The amputated segment included the sterile and germinal matrix. He underwent defatting and composite grafting of the amputated segment followed by K-wire fixation of his proximal phalanx fracture.
  
  
  RESULTS
  In his 1-week follow-up, the patient's composite graft-including his nail bed-demonstrated complete survival. At one month, the composite graft maintained stable soft tissue coverage and showed signs of nail plate regrowth. Four months after repair, he was able to return to light duty and was advanced to full duty within 5 months. He continued to report gradually improving hypersensitivity at the margins of the graft and stiffness of the interphalangeal joint. At five months he regained full mobility of his carpometacarpal joint. The range of motion of his interphalangeal and metacarpophalangeal joint were 0 to 10 degrees and 0 to 25 degrees, respectively. He was able to oppose his thumb to all 4 digits. Six months after repair, he demonstrated protective sensation of the tip of the thumb.
  
  
  CONCLUSIONS
  Composite grafting of the thumb, even in less than ideal cases, can still provide useful length for function as a opposable post and can be considered in reconstruction of thumb amputations at or proximal to the lunula.
authors.affiliation: Division of Plastic Surgery, University of Louisville.
authors.forename: J
authors.initials: J
authors.lastname: Choo
authors.affiliation: University of Louisville Medical School.
authors.forename: B
authors.initials: B
authors.lastname: Sparks
authors.affiliation: Rex Robley Veterans Affairs Medical Center, Louisville, Ky.
authors.forename: M
authors.initials: M
authors.lastname: Kasdan
authors.affiliation: Division of Plastic Surgery, University of Louisville.
authors.forename: B
authors.initials: B
authors.lastname: Wilhelmi
keywords: composite graft; distal thumb injuries; finger amputation; replantation; thumb amputation
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