Functional reconstruction of the thumb by heterotopic thumb-to-thumb replantation and secondary opponensplasty in bilateral amputation in the upper extremities

Abstract

In traumatic amputations in the upper extremities, replantation has been commonly attempted with high success rates. However, successful replantation implies both the maintenance of length and good functional outcomes of the restored hand. Since the thumb accounts for 40% to 50% of hand function, the utmost priority is on the salvage of the thumb. In cases when replantation is not feasible, various efforts have been made to replace the thumb, including pollicization of the index finger, toe transfer, lengthening of the thumb stump, and deepening of the first web space. Alternatively, heterotopic thumb-to-thumb replantation has been suggested as a rescue plan in rare circumstances of bilateral amputation in the upper extremities. However, even if heterotopic replantation is successful, there are situations in which a severe crushing injury to the thenar muscles of the recipient’s thumb causes opposition failure of the reconstructed thumb. We report a case of functional reconstruction of the thumb in a rare case of bilateral mangling amputations in the upper extremities, by a heterotopic thumb-to-thumb replantation combined with secondary opponensplasty to compensate for the opposition failure.