Reconstruction of the Thumb After Failed Replantation Using Part of the Amputated Thumb and a Pedicled Flap - Report of Two Cases.

The thumb is the most important digit of the hand, and thumb amputation results in a 40% loss of hand function. The gold standard of management in thumb amputation is replantation. Late reconstruction methods of a lost thumb include wrap‑around great toe flap, deepening of the first web space, osteoplastic procedures, and others. The aim of this article is to pre­sent a rarely used method of thumb reconstruction after a failed replantation using non‑vascularized bone from the previously replanted thumb and a pedicled flap from the body wall (abdominal flap). We present the treatment outcomes of two patients after a failed thumb replantation in whom the thumb was reconstructed using non‑vascularized bone from the previously replanted thumb covered with a pedicled abdominal flap. The functional outcome was assessed using the QuickDASH questionnaire and the Kapandji opposition score. Elongation of the thumb relative to the initial amputation level was achieved in both patients. One patient scored 6.82 points on the QuickDASH scale, indicating a very low level of upper limb disability. The Kapandji score in that patient was 7–9 points, corresponding to good-to-excellent thumb opposition function. In the second patient, the QuickDASH score was 9.09 points, also indicating minimal functional limitations, and the Kapandji score was 4–6 points, corresponding to moderate opposition function. Comparatively, the first patient achieved better function of the reconstructed thumb. A failed thumb replantation does not necessarily lead to amputation of the entire necrotic replanted thumb segment. In selected clinical cases, the non‑vascularized bony part of the thumb can be used for early reconstruction with a pedicled body‑wall flap even several weeks after the primary replantation. This method has not been previously described in the domestic literature.