Background: Thumb amputation due to high-voltage electrical injury represents a unique challenge to the reconstructive microsurgeon due to the uncertain reliability of recipient vessels. The zone of injury in these particular burns is often difficult to elucidate from physical examination, and the ideal time for reconstruction has not yet been well characterized. We present 3 cases of successful microsurgical reconstruction in 2 patients via toe-to-thumb transfer following electrical injury resulting in thumb amputation. Methods: Retrospective review of a single surgeon’s experience identified 2 patients who sustained electrical injuries resulting in thumb amputation (1 bilateral and 1 unilateral), with subsequent successful reconstruction via free toe-to-thumb transfer. Results: Both patients had successful thumb reconstruction after microvascular toe-to-thumb transfer. Both patients regained sensibility, motion, and sufficient pinch strength to use their reconstructed thumbs in everyday activities, with minimal donor-site morbidity. Conclusions: Microsurgical reconstruction of the thumb following amputation as a result of electrical burn can be particularly challenging due to extensive soft-tissue injury. We report 3 cases of successful thumb reconstruction using this technique with good functional outcomes. Microsurgical reconstruction of the thumb should be considered even in patients who have experienced thumb amputation as a result of electrical injury.
Bregman et al. (Fri,) studied this question.