Doctor, sew the thumb back on

  • Yevgeny Shuhatovich
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  • Bone - Carpal - Compensation - Distal - Dushi - Fernando - Fracture - hand - Injury - levaro - Ligament - Marcos - masson - Microscope - Microsurgery - nerve - parameswaran - Radius - Replantation - shuhatovich - Surgery - tendon - Thumb - Tunnel - Work - Workers - Workmans - Yevgeny -

The thumb contributes approximately 50 % of the function of the hand. This is because the thumb is a strong and adaptable digit that opposes the rest of the fingers in the hand. The thumb can perform fine manipulation to grab small objects, for example pinch. It also rotates when you need to grip a heavy object. It is the thumb’s functional versatility that makes the thumb so valuable.

A thumb amputation is a devastating injury as it can result in permanent disability if not properly treated. One such case is that of a young male, (we’ll call him J.) who sustained an amputation of the right thumb by a tractor.  His injury resulted in tendons, nerves and blood vessels to be ripped off all the way from the forearm. The thumb itself was crushed and heavily contaminated with rocks, dirt and grass.

J. was flown by helicopter for immediate reattachment (replantation). His procedure required a high level of expertise, borrowing tendons from other fingers to restore motion to the thumb. His blood vessels had large defects, requiring pieces of vein to restore blood flow. These grafts were obtained from other parts of his hand to bridge large defects in arteries and veins using a microscope. Nerve defects were reconstructed by borrowing nerves from the less important ring finger. These nerves were connected to the nerves of the thumb to restore more important thumb sensation.  He stayed 5 days in the hospital taking blood thinners to avoid clotting off his vessel reconstructions.  After his release from the hospital, J. followed with a structured hand therapy and home exercise program.

When Dr. Levaro first saw J. in his follow up appointment, his thumb had excellent blood flow and already showed some motion. However, he has continued improving his motion and control. 3 months after surgery, he was able to return to limited work. His sensation continues to improve.

Currently, J. is very excited about the great possibilities now that he has his thumb back. He can write and continues working towards improving thumb dexterity, grip and strength. This means a lot to him and he is grateful for all the efforts required to help him regain hand function.

Amputations frequently happen in the work place. Immediate competent medical and surgical attention is critical in order to have a chance of saving the amputated part and regain function.  Postoperative therapy has proven to be as necessary as the procedure itself to obtain excellent outcomes.