Osteoplastic Reconstruction for Post Traumatic Thumb Amputations Around Metacarpophalangeal Joint PC11-PC13
Dr. Swapna Nachiket Athavale,
Post Graduate, Department of Plastic Surgery, PMSSY Building, 2nd Floor,
Victoria Hospital Campus, Fort, Bangalore-560002, India.
Introduction: Loss of a thumb due to trauma warrants replantation which is the best method of reconstruction. When replantation is not possible, thumb reconstruction is the procedure of choice. The level of thumb amputation guides the type of reconstruction. There are five goals for reconstructing a thumb: restoration of (1) functional length (2) stability (3) mobility (especially opposition) (4) sensibility and (5) aesthetic appearance.
Aim: This study was conducted to evaluate the functional outcome of two main techniques of osteoplastic thumb reconstruction (1) Osteocutaneous distally based radial forearm flap (2) Groin flap with iliac crest bone graft. Materials and Methods: Total 13 patients underwent osteoplastic reconstruction in the duration from August 2012 to December 2014. Thumb reconstruction was done using distally based radial forearm osteocutaneous flap in 7 patients and two staged reconstruction by groin flap with iliac crest bone graft in 6 patients. Postoperatively results were assessed in terms of range of motion, hand grip, functional recovery, donor site morbidity and patient satisfaction.
Results: All reconstructive thumbs were functionally acceptable. Cosmetically, donor site morbidity was an issue for 2 patients with radial forearm flap and 1 patient with groin flap. Suture line dehiscence and plate exposure required intervention in local anaesthesia in one patient with radial forearm flap. After reconstruction absence of pain, temperature and touch sensation were observed.
Conclusion: We suggest that osteoplastic reconstruction is a reliable procedure in terms of stability, length, strength and opposability if basal joint is intact. Most of the patients in this study were manual labourers who went back to previous occupation and were able to use their thumb for daily activities for earning livelihood.