| Popis: |
Introduction: The reconstruction of mangled extremities is a heavily contentious topic, particularly when the thumb is involved. Thumb reconstruction is attempted at a rate that falls below the recommended guidelines, despite the digit’s significance. This article reviews leading research and concurrent guidelines, alongside a case presentation, in order to offer a distinct perspective on the management of mangled thumbs. Contraindications to Salvage of a Thumb: There are several contraindications to the reattachment to any digits, which can be broadly categorised as follows: * General absolute contraindications -Life-threatening associated injuries -Severe systemic illness * Local absolute contraindications -Extensive contamination -Wrong conservation of amputated part * Relative contraindications -Comorbidities -Advanced age -Psychosis -Avulsion injuries -Multiple-level injuries Clinical Case: A 21-year-old precision lathe operator sustained a mutilating industrial accident to his left thumb, which was heavily contaminated by grease and paint. The patient underwent 10 hours of surgery, and several failed attempts at revascularisation; however, the thumb survived completely. Necrosis of the volar skin had to be debrided and repaired a month after discharge, but the flap healed nicely, and the patient recovered with minimal difficulties and returned to his occupation. Discussion and Conclusion: A tailored, comprehensive biopsychosocial approach is recommended when considering the reattachment of the thumb. In many cases, an attempt to reattach the thumb should be undertaken despite certain contraindications and the severity of the injury, as the benefits of a successful procedure will likely outweigh the potential damage done by a failed operation. |
