Thumb Tip Amputations
Since the thumb is the most important appendage of the hand, loss of even a part of it has profound implications on how the patient is able to use his hand. Hence, if a significant portion of the the thumb has been amputated, there is an indication to try to replant the piece, especially in children and women.
IN those cases where the amputated part is not salvageable, there are a number of options in treatment depending on the level of the amputation and whether or not the patient is right-or left-handed.
As a rule, any amputation proximal to the interphalangeal joint will pose considerable handicap in terms of using it for grasping or handling small objects. The remainder of the thumb can be used only by pinching objects between it and the palm or the base of the index.
If this is NOT his dominant hand, they may be able to adapt well to its shortness.
If this is the hand that the patient writes with, he will need to learn to use the index and long to write, unless extra length can be brought to the thumb.
Lengthening the thumb would require either lengthening the phalanx with an additional flap to cover the extra bone, or by going straight to a toe-to hand transplant.
Amputations just distal to the last joint can be used surprisingly well, and there is a convention to not perform any further reconstruction other than to make a healthy sensate tip.
This is best done with the use of the Moberg Flap, or the volar advancement flap.
Unlike other fingers, the thumb has a separate blood supply to the skin of the dorsum. So the entire volar surface of the thumb can be elevated and advanced to cover the tip. As much as 1 ½ cm of skin can be brought into use. It allows us to salvage thumbs when the pulp has been destroyed, but the nail complex is still present.
A number of examples of reconstruction are presented below.
Most of these procedures are done under a regional anesthetic block on and outpatient basis.