Orthopaedic MD

Since the first replant 40 years ago, thousands of severed body parts have been reattached, preserving the quality of life for thousands of patients through improved function and appearance that the void remaining after amputation cannot provide. Ronald Malt performed the first replantation on May 23, 1962 at Massachusetts General Hospital on a 12-year-old boy who had his right arm amputated in a train accident (Malt, 1978). This amputation occurred at the level of the humeral neck.
Synonyms and related keywords: hand amputation, hand replantation, multiple-digit replantation, severed body part repair, trauma, replant, amputee, tendon transfers, wrist arthrodesis, guillotine amputation, avulsion amputation
Wilhelmi, Lee & May 2006

Full text and illustrations of 1991 textbook

Microsurgical reconstruction is used for complex reconstructive surgery problems when other options such as primary closure, healing by secondary intention, skin grafting, local flap transfer, and distant flap transfer are not adequate. Microsurgery may not be the best solution for all reconstructive dilemmas and certainly is not the first choice in the reconstructive ladder. However, it can offer the reconstructive surgeon a wide range of possibilities for complex reconstruction. In specific cases, such as mandibular reconstruction, free tissue transfer may be the best option. The purpose of this article is to outline the principles of microsurgery, specifically the principles of surgical planning and operative technique that will optimize success.
Synonyms and related keywords: free flap reconstruction, microsurgery, free flap, free tissue transfer, workhorse flap, latissimus dorsi flap, scapular flap, lateral arm flap, radial forearm flap, rectus abdominis flap, omental flap, jejunal flap, gracilis flap, fibula flap, great toe flap, principles of microsurgery
Author: James Chang, MD

Replantation of completely amputated digits has been a medical reality since 1961, when Komatstu and Tami first successfully replanted a completely amputated thumb. Amputation of digits is common. Approximately 100,000 digital amputations occur per year in the US. Of these, an estimated 30% are suitable for replantation. The exact number of replantations performed yearly is unknown. However, the number appears to be decreasing, secondary to more rigid selection criteria, improved workplace safety procedures, and better designed protection devices on power tools.
Author: L Andrew Koman, MD 2002

The thumb plays an important role in hand function. Daily tasks involving pinch, grip, grasp, and precision handling are more easily accomplished with an opposable thumb. Traumatic loss, congenital absence, or hypoplasia diminishes or eliminates the thumb's prehensile abilities and may affect overall hand function.
Attempts to restore thumb function were recorded as early as 1874, when Huguier reported on the "phalangization" of the thumb metacarpal, which was carried out by deepening the first web space.1 In 1900, Nicoladoni described a reconstruction procedure following traumatic amputation of the thumb in which a staged, pedicled transfer of the great toe was performed.2 Development of microsurgical techniques allowed successful transfer of a toe to a thumb in monkeys in 1965 and in a human in 1966.3, 4
Reports of technical refinements in the toe-to-thumb transfer subsequently appeared in the literature.5, 6 Congenital absence of the thumb from thalidomide exposure provided experience with index finger pollicization for thumb reconstruction.
Synonyms and related keywords: thumb injury, hand injury, toe-to-thumb transfer, toe to thumb transfer, thumb replantation, thumb reconstruction, osteoplastic thumb reconstruction, Moberg flap, Littler neurovascular island flap, kite flap, dorsal metacarpal artery flap, microvascular toe transfer flap, wraparound flap, toe-to-hand transfer, toe to hand transfer, phalangization, pollicization, pouce flottant thumb, Blauth type IV, Blauth type 4, congenitally absent thumb, Blauth type V, Blauth type 5, thumb amputation, toe amputation
Bueno & Wilhelmi 2007