Delayed Thumb Replantation at 24 Hours Following Saw-Cut Amputation at the Base of the Proximal Phalanx: A Case Report and Review of Outcomes.

Thumb amputation is a severe injury that significantly affects hand function. Replantation remains the preferred treatment, particularly in young and active individuals. However, prolonged ischemia time is traditionally considered a limiting factor for successful replantation. We present a case of a 25-year-old right-hand-dominant male who sustained a traumatic saw-cut amputation of the left thumb at the base of the proximal phalanx and underwent successful replantation approximately 24 hours post-injury. Surgical management included skeletal fixation with Kirschner wires, microvascular anastomosis, tendon repair, and nerve coaptation. Serial follow-up demonstrated satisfactory wound healing and progressive functional recovery. At six months, the patient achieved near-normal grip strength, pinch strength, and full thumb opposition. This case highlights that delayed thumb replantation can still result in favorable functional outcomes when appropriate surgical technique and postoperative rehabilitation are employed.