Osteoplastic Thumb Reconstruction in the Immediate Setting
Yusha Liu, MD, PhD1, Erin A. Miller, MD1, Adnan Prsic, MD2 and Dennis S. Kao, MD1, (1)University of Washington, Seattle, WA, (2)Yale School of Medicine, New Haven, CT
Introduction
The thumb plays a critical role in hand function, and amputation is a devastating injury. Often, reconstruction is a lengthy ordeal. Here, we present osteoplastic reconstruction in an immediate setting to restore functional length to the thumb when replantation is not an option.
Materials & Methods
Over a two-year period, six patients who sustained thumb amputations underwent immediate osteoplastic thumb reconstruction at our institution. Their electronic medical records were reviewed and data was collected retrospectively. All cases were performed under general anesthesia. Intraoperatively, bone was harvested from the amputated thumb or an adjacent unsalvageable digit. All overlying soft tissue, including periosteum, was removed. Bony fixation was performed with 26-gauge 90-90 interosseous wiring. Soft tissue coverage was provided by a pedicled groin flap. Postoperatively, the affected upper extremity was immobilized, and patients underwent groin flap division one month later. Subsequent flap debulking was delayed for at least three months after flap division.
Results
The operative time for the first stage of reconstruction averaged 146 minutes (range, 87-290 min). The time between hospital arrival and surgery for definitive coverage averaged 3.4 days (range, 0.13-9.4 days). Postoperative hospital length of stay averaged 3.0 days (range, 1.7-5.1 days). No patients required a blood transfusion as a result of this procedure.
In addition to flap division surgery, patients underwent an average of 1.3 revision procedures (range, 0-2), primarily for debulking and hardware removal. One patient required a corrective osteotomy to bring the thumb tip into flexion. Three patients had complications: one cellulitis which resolved with oral antibiotics, one hardware failure requiring revision fixation, and one deep infection requiring repeat debridement.
When measuring from the metacarpal base to reconstructed thumb tip, the average bony length of the thumb remnant post-injury was 5.1 cm (range, 0.8-7.3 cm), and the reconstructed thumb length averaged 8.17 cm (range, 4.3-10.7 cm), representing an average gain in length of 3.1 cm (range, 0.9-7.7 cm).
Conclusions
Immediate osteoplastic thumb reconstruction is a safe, reliable alternative for restoring length when replantation is not feasible. Advantages of this approach include short operative time and hospital length of stay, straightforward technique that does not require microsurgical skills, use of bone from an unsalvageable digit that would otherwise be discarded, and minimal donor site morbidity. Prospective studies with a larger patient cohort are needed to evaluate long term function and patient-reported outcomes.
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