Thumb reconstruction with a double flap after thumb replantation failure using a reverse homodigital dorsoulnar flap and a cross-finger flap

Abstract

After replantation and salvage procedures have failed in a heavy smoker, surgeons are hesitant to consider future strategies. We introduce a case in which the length and function of the right thumb were preserved as much as possible by double flap surgery after replantation failure. The thumb of a 55-year-old man without underlying disease was amputated by an electrical chainsaw at work. He presented at the emergency room of our hospital, and emergency surgery was performed for exploration and stump replantation. Unfortunately, the replantation surgery failed, and the distal stump was necrotized. Thus, double flap surgery was planned after replantation failure, and thumb reconstruction was performed using a reverse homodigital dorsoulnar flap and a cross-finger flap. A portion of the flap later had to be revised, but the functional and aesthetic results obtained were far better than expected for a simple stump revision procedure.