TRANSFER OF A SEVERELY DAMAGED DIGIT TO RECONSTRUCT AN AMPUTATED THUMB

We retrospectively reviewed the results of reconstruction of a traumat ically amputated thumb with use of an adjacent severely damaged digit in twenty-seven patients (twenty-five male and two female patients). T he mean duration of follow-up was nine years (range, two to twenty-one years). The mean age at the time of the reconstruction was thirty-fou r years (range, thirteen to fifty-six years). Five patients had the re construction on the day of the injury and twenty-two, after a mean del ay of five months (range, fifteen days to thirteen months). Segments o f the index finger were used in twenty-two patients; of the long finge r, in four patients; and of the ring finger, in one patient. There wer e four complications: necrosis of the dorsal skin in one patient, refl ex sympathetic dystrophy in one patient, and contracture of the first web space in two patients. Discriminative sensibility was ten millimet ers or less, according to the Weber test, in twenty-four thumbs. Corti cal integration with reference to the recipient thumb, on stimulation of the pollicized segment, was good in ten patients. Eleven patients c ould achieve tip-to-tip contact between the thumb and the little finge r and twenty-five patients, between the thumb and the most radial fing er. The ability to perform activities of daily living was considered g ood for ten patients, fair for eleven, and poor for six. Only digits w ith a nail, either present on the transferred segment or as a result o f a free vascularized nail transfer, were considered to have a good co smetic result. Although these results are far from impressive, the rec onstruction is a viable alternative for selected patients because it m aintains the ability to grasp objects and to oppose the digits.