Great Toe Transplant versus Thumb Replant for Isolated Thumb Amputation: Critical Analysis of Functional Outcome.

Author(s): GD Rosson , Bunke GM, and Bunke HJ

Source: Microsurgery 28:598–605, 2008.

Summary:

This article presents the author’s significant experience with the care of patients with thumb amputations by critically examining and comparing the functional outcome of isolated thumb replantation versus great toe transfers.

Ninety-one patients with isolated thumb amputation that were replanted had an 85% survival rate. Failed replants usually resulted from crushing or avulsing injuries. Function of replanted thumbs was better in sharp compared with crush/avulsion injuries. Forty-three isolated thumb reconstructions had a 93% success rate. Function was comparable with thumb replants from sharp injuries. Interphalangeal motion was significantly better in great toe transplants than in replanted thumbs of the crush/avulsion type.

Amputation of the thumb can be one of the most debilitating hand injuries.  To adhere to the tenet “replace like with like,” surgeons should attempt to replant the amputated thumb whenever possible.  However, in the event that the original thumb cannot be replanted, a decision must be made about reconstruction of the hand by other means.  Great toe to hand microsurgical transfer is one such reconstructive option and this report is the first comparison of the functional results of thumb replantation compared to great toe-to-thumb transfer.  The results are significant because they suggest that, despite popular belief, replantation does not necessarily provide superior thumb function to other reconstructive means.  Specifically, replantation of crushed or avulsed amputations have inferior functional outcome compared to great toe transfers in experienced hands.