Conclusion and Results (Outcome and follow-up):
In the operating theater, the digital artery from the ulnar aspect was
repaired with 9-0 nylon. The digital veins were badly crushed and only
one small 0.7mm vein was found on the dorsal aspect of the thumb, but
since the smallest coupler size we had was 1mm it was difficult to
perform the anastomosis. A trial of topical papaverine, 1mg/ml, was
given to vasodilate the vein and after many cycles of papaverine in
addition to mechanical dilation; the vein could accommodate the 1mm
coupler and anastomosis of the veins was possible within 25 minutes. One
digital nerve was identified and repaired on the radial aspect. Flexor
and extensor tendons were repaired with PDS thread, however the flexor
tendon was shuttered badly. The bone was shortening by 0.5cm from the
proximal phalanx on the amputated side. Wound was closed with prolene
and the coupler was covered with a small skin flap. The ischemia time
was already 10 hours before restoring circulation (figure 3,4).
The patient was followed in the clinic for re-assessment and wound care.
Almost two months after the replantation, the patient was noted to have
left thumb flexor pollicis longus (FPL) tendon rupture on examination.
So secondary FPL tendon repair was done. Four months after the primary
surgery the patient had good range of movement and function of the left
thumb, his wounds were healed and he had good sensation and circulation
(figure 5). The patient was discharged from our care with full
satisfaction.