Reconstruction microchirurgicale du pouce après amputation

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The patient, male, suffers the amputation of his right hand’s thumb and a serious damage to the surrounding tissue and musculoskeletal structure. The impact, caused by an accident with a fan, requires the design of a microsurgical procedure by Dr Piñal. thumb reconstruction

The problem

The pre-operative scenario clearly shows the disabling consequences of the accident. The bone affection and the extension of the damage in muscles and tendons has as a direct result – among other multiple functional and aesthetic impacts – the inability to perform the pincer movement; a fundamental maneuver for the performance of the most basic daily tasks. thumb reconstruction

Initial situation of the affected extremity — The image above (views of the palm and the lateral segment of the extremity) makes clear the seriousness of the accident, in a preliminary phase of the surgical procedure.

The goals

The clinical goals in this case are (primarily) the reconstruction of the damaged area and the recovery of functionality, through its revascularization and the partial transfer of the hallux or big toe to the hand. An implementation of the trimmed toe technique by Dr. Piñal that improves the final appearance of the donor area.

The plan

The Spanish surgeon and his team proceed to the microsurgical reconstruction of the hand, taking a vascularized free flap of the patient’s forearm that facilitates the recovery of the blood supply and acts as a cover.

These brief images allow to visualize the vascular beat during the intervention, before Dr Piñal finishes the arterial and venous reconnection by microsurgery in the affected area.

In turn, the big toe is partially transferred to the hand, using Kirschner wires to facilitate the consolidation of the newly inserted bone and the structure preserved after the accident, that is, to make osteosynthesis possible

Some of the main details of the surgical procedure — In the combination of photographs above several of the main details of the advanced phase of the procedure are observed. On the left, highlighted with semitransparent circles: upper part of the Kirschner wire (blue), vascular clamps (yellow) -which avoid bleeding during surgery- and markers of arteries and veins (violet). In addition, both images show the extreme precision of the stitches applied in this profile of reconstructive microsurgery.

The results

The success of the procedure designed by Dr Piñal is visible in the functional recovery of the upper limb and in the limitation of the aesthetic impact, both in the hand and in the donor foot. Once the surgical process is completed, the patient can perform the tasks developed prior to the accident. thumb reconstruction

Postoperative results after 15 days — Results of the reconstruction process 15 days after the main intervention, without any additional surgery being performed.

Aesthetic-functional recovery of the patient’s hand after two years. In the lower left corner of the screen the starting situation is inserted to offer an evident reference of the success of the surgery.

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