Medizinische Universität Graz - Research portal
Selected Publication:
Parvizi Motlagh, D.
Replantation of traumatic thumb amputation at the Department of Plastic and Reconstructive Surgery at the University Hospital of Graz, Austria
[ Dissertation ] Medical University of Graz; 2007. pp.
- Authors Med Uni Graz:
- Parvizi Daryousch
- Advisor:
- Scharnagl Erwin
- Altmetrics:
- Abstract:
- The thumb is by far the single most important digit and is responsible for 40% of hand function. Its role is critical in prehension and grasping. Given its importance, reattachment is indicated in nearly all thumb amputations. Following the first successful revascularization of a thumb by Kleinert and Kasden in 1965, Komatsu and Tamai reported the first thumb replantation in 1968. By the late 1970s, thumb replantation had become relatively routine, and is now state of the art for reconstruction of an amputated thumb. Currently, the indications for digital replantation include all thumb amputations, multiple finger amputations, and all amputations in children. The goals of replantation are (1) to restore circulation to the amputated part and (2) to reconstruct the bone, nerve, and motor units to provide a functional digit. This dissertation consists of a theoretical and a clinical part. The theoretical part comprises the pertinent surgical anatomy of the thumb, demonstrating all important anatomical structure for replantation. The principles of microvascular surgery with its pertinent instruments and suture techniques are also represented in this part. The final chapter of the theoretical part discusses indications and contraindications of thumb replantation, and describes preoperative care, surgical technique and postoperative monitoring. The first aim of our clinical investigations was to review our series of thumb replantations over a period of 12 years at the Department of plastic and Reconstructive Surgery at the Department of Surgery, University Hospital, Graz, Austria. The age, cause and type of injury, level of amputation, and use of arterial or venous grafts were reviewed and correlated with survival rates of the replanted thumbs. The overall survival rate was 68.8%. Of the 19 Thumbs that were re-explored for vascular compromise, 63% were successfully salvaged. Our study indicates that there is a statistically significant difference in survival of thumb replants depending on the age of patients. In our series, we had a much lower survival rate in patients who were younger than 18 (40%) of older than 65 (42.8%), than in patients in the age range of 18 to 65 years (76.6%). No statistical difference was found in survival of thumb replants when the cause and type of injury, level of amputation, and the use of arterial or venous grafts in severe crushing and avulsion injuries.