Amputaciones traumáticas del pulgar: Tratamiento primario, principios y resultados

background: the objective of this paper is to establish the actual principles of primary treatment in traumatic thumb amputations and evaluate the results. methods: 25 patients who underwent complete or incomplete amputations of their thumbs between 2004 and 2009 were retrospectively evaluated. eighteen patients had complete thumb amputation (seven distal to the lunula), and seven had incomplete amputations. seventeen were clear cuts, six were avulsion or degloving injuries, and two had compression injuries. patients' age averaged 32. ischemia time averaged seven hours. the thumb was replanted in eleven cases, it was revascularized in seven, in four cases moberg's advancement flap was performed and in three a pedicled neurovascularized island flap was used. seven cases required a by-pass. results: follow-up averaged 20 months. three replants failed. four patients needed secondary pedicled island flaps. all patients recovered protective sensation, and 17 returned to their previous activities. six patients refer cold intolerance. the dash score averaged 20 points. conclusions: when a traumatic thumb amputation occurs, good aesthetic and functional results can be achieved through: an adequate selection of the best reconstructive procedure according to the level of amputation, a meticulous microsurgical technique, a precise repair or reconstruction of the injured structures, adequate coverage of the repaired tissues, and specialized physiotherapy.