Plastic & Cosmetic Surgery Case Reports
THUMB LOSS: CASE REPORT
A patient with thumb loss in her right hand with the distraction device in situ.
View from the palmar aspect.
Consolidation phase after distraction. Note the degree of thumb lengthening.
Palmar view after web space deepening.
With support from her other fingers, the patient can now hold a pen and write.
X-ray of the thumb shows the incorporated bone graft with the miniplate in situ.
This 23 year old female patient came to the outpatient department with an amputated thumb on right side following injury in a machine. The amputated part was badly crushed so no replantation was possible. The local hospital had therefore sewn her wound up and had referred her to a higher center for a possible reconstruction. On examination, the thumb was amputated from just beyond the level of the MCP joint of the thumb. She was given the option of reconstruction of thumb using a toe but she was not ready to sacrifice a toe.
Therefore, she was planned for distraction osteogenesis of the thumb metacarpal informing her that this was quite a long process so that she had to be patient.
In the first stage as shown above, the external distractor was applied after the osteotomy was made in the metacarpal. After allowing a latent period of 5 days, the device was activated with distraction of bone segments progressing for 3 months. Once the final level of distraction of segments were achieved, the device was kept on for the period of consolidation. However, a clinical examination and follow up X-ray did not show good bone growth after a year so the patient was planned for bone grafting after a year.
A cortico-cancellous bone graft was harvested from the iliac crest on right side and the bone segment was sized and attached to the distracted segments using a miniplate and screws. Another period of consolidation was allowed lasting for 6 weeks. The distraction device was then removed.
In the final stage the first web space was deepened and the adductor insertion was placed at the base of the newly created web space. The patient was then subjected to extensive physiotherapy.
A newly created thumb, albeit smaller than normal was the outcome. She could hold a pen using her new thumb and write everything. The patient satisfaction was immense.
Distraction osteogenesis of the thumb can be a useful surgical method of thumb reconstruction for patients who do not wish to sacrifice a toe and have an intact metacarpal. However, patients need to understand that this method of reconstruction requires a lot of patience and cooperation on part of the patient and multiple surgical sittings would be required. The sensations over the distal part are excellent and with proper physiotherapy all thumb functions can be achieved so this is an important surgical option.