Thumb reattachment : “A joining ray of hope”

It is often said that one of the key defining traits which distinguishes mankind from animals is an opposable thumb. While many may take that remark in jest, there is in fact much truth to it. Opposable thumbs are essential for efficient gripping of objects as well as performing fine manipulations upon them. Amit, a factory worker from the suburbs of Kolkata is one such person who has experienced a loss of thumb while working in the factory and was treated by Dr. Anupam Golash, CMRI Department of Plastic, Reconstructive & Hand Surgery.

“I am the only bread winner of my family and was at the brink of losing this asset due to an unfortunate accident during work.  I was extremely disturbed  when my right thumb got amputed in the accident . Given the importance of the right thumb in day to day activities, my life had come to a complete stand still, till I consulted Dr. Anupam Golash, Plastic and Hand Surgeon, CMRI,Department of Plastic, Reconstructive &Hand Surgery and was advised to undergo a reconstruction surgery.  He advised me a emergency re – implantation surgery to join back my amputed right thumb. The surgery took six hours and my thumb was joined successfully.  After  surgery I had to go through  weeks of recuperation, physiotherapy ” says Amit, a factory worker from the suburbs of Kolkata.

Dr. Golash explains, “After all, virtually all the early accomplishments of human civilization were the result of sheer manual labor! Thus, the importance of the opposable thumb to man’s uniqueness and development is no laughing matter. Though it is not the sole aspect differentiating man from animals, it is certainly a significant one. In Amit’s case  blood vessels and tendons were avulsed for a long distance , so I had to use  advanced techniques to replace the damaged vessels.”

The rejoining of thumb generally involves the joining of Bone, then tendons, nerves and then very tiny arteries and veins under powerful microscope..  There are several steps that are involved in the rejoining process.

Step 1: Damaged tissue is carefully removed.

Step 2: Bone ends are shortened and rejoined with pins, wires, or plates and screws. This holds the part in place to allow the rest of the tissues to be restored.

Step 3: Muscles, tendons, arteries, nerves and veins are then repaired. Sometimes grafts or artificial spacers of bone, skin, tendons and blood vessels may be needed, too. The grafts can be from our own body or from a tissue bank.

Dr. Golash further explains, “Replantation refers to reattachment of a completely severed part, meaning there is no physical connection between the part that has been cut off and the person. Reattachment can be surgically performed for the finger and a few other detached body parts, such as the hand or arm. In case of a thumb, if it is completely damaged and cannot be rejoined then in that case we can use a toe to reconstruct a thumb.”.

Patients have a very important role in the recovery process. Generally, patients generally take around 3 to 6 months’ time. But generally, after 3 months the patients can get back to their daily chores. Replanted part depends partially on re-growth of two types of nerves: sensory nerves that let you feel and motor nerves that tell your muscles to move. Nerves grow about an inch per month. The number of inches from the injury to the tip of a finger gives the minimum number of months after which the patient may be able to feel something with that fingertip. The replanted part never regains 100% of its original use, and most doctors consider 60% to 80% of its original use an excellent result.

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