Thumb avulsion: Results of replantation/revascularization

During a 9-year period, 39 thumb avulsions required emergency replantation/revascularization at our institution. Amputation was complete in 28 (72%) cases and involved the dominant thumb in 31 (80%). Farm machinery was the source of injury in 33 (85%) cases. Follow-up ranged from 7 months to 6 years. Only 10 of the revascularization attempts (26%) were successful; the remaining attempts required amputation at the level of the injury. In two (18%) of the 11 partial amputations and in eight (29%) of the 28 complete amputations, revascularization was successful. In eight (31%) of the 26 thumbs in which vein grafts were used, revascularization was successful, while one of the other two successes involved a transfer of the radial digital artery of the index finger. In six of the ten successful revascularizations, nerve repair was attempted, but without further procedures, none of the six digits regained two-point discrimination of less than 1 cm.