Le Dr Piñal discute des techniques de reconstruction microchirurgicale du pouce pour le programme de formation du Pulvertaft Hand Centre

30 avril, 2021


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The Spanish surgeon laid out his strategies for approaching complex thumb amputations in a single step.

Dr. Piñal took part as a lecturer last Monday in the training program of the Pulvertaft Hand Centre (United Kingdom). During the fifty minutes of his presentation, he detailed the set of techniques of his strategy of thumb reconstruction by microsurgery.

Piñal, through different clinical cases, focused on what he calls extreme thumb losses: proximal amputations (towards the base of the thumb) with damage to the tissues and thenar muscles, which enable adduction, abduction, flexion and opposition of the thumb and, key, therefore, for basic functions of the hand such as pinch and grip.

The Spanish surgeon compiles the guidelines of the work laid out in his presentation for the Pulvertaft in the article ‘Extreme Thumb Losses: Reconstructive Strategies‘, published by the journal of the American Society of Plastic Surgeons (ASSPS), Plastic and Reconstructive Surgery (PRS).

The paper presents new strategies for addressing complex amputations of the thumb in a single stage using existing muscles, immediate free tissue and toe to hand transplant.

As the article unfolds, the Spanish surgeon considers that the proximal amputations of the thumb go beyond the “simple” loss of a finger, grouping them under the denomination of extreme thumb reconstruction due to their complexity. The Spanish surgeon analyzes the cases of 24 patients to validate his approach.

Piñal states that in these clinical contexts the surgeon should pay attention not only to the loss of the thumb per se, but also to the tissues web and the thenar muscles, among other elements. In turn, recommends abandoning practices like pollicization or the two stages reconstruction using pedicled groin flaps followed by toe to hand transferences.

‘Extreme Thumb Losses: Reconstructive Strategies’ was awarded by PRS as the best article of 2019 in hand plastic and reconstructive surgery, in its Best Papers Awards 2020.

Surgical scheme
In the image above, Dr. Piñal’s surgical scheme for a extreme thumb loss case.

Dr Piñal has performed more than 500 toe to hand transplants: the surgeon with the largest number of interventions of these characteristics on a global scale.

Born in Santander, northern Spain, in 1960, Dr Francisco del Piñal, director of the Instituto de Cirugía Plástica y de la Mano Piñal y Asociados and the Hand Surgery and Microsurgery Unit at Hospital Vithas Madrid La Milagrosa, is considered one of the world’s best upper limb surgeons. His contributions in fields like microsurgical reconstruction of the catastrophic hand or arthroscopic surgery techniques on wrist fractures are endorsed and used internationally.

The Pulvertaft Hand Centre, within the Royal Derby Hospital, has an extensive trajectory in the treatment of hand and wrist pathologies. It’s named after Dr. Guy Pulvertaft (1907-1986), a prestigious surgeon and first president of the British Society for Surgery of the Hand and the International Federation of Societies for Surgery of the Hand (IFSSH).

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