Pune, July 28: Doctors at Sahyadri Super Speciality Hospital Nagar Road - A network hospital of Manipal Hospitals successfully replanted the amputated right thumb of a 30-year-old IT professional after a severe bike-related accident; left him with a complex crush and rotational avulsion injury. The five-hour emergency microsurgery was performed within four hours of the accident, restoring blood flow to the thumb and significantly improving the chances of saving it.
The accident happened while the patient was cleaning his motorcycle. The rear wheel suddenly rotated, trapping his thumb in the spokes and tearing it off completely. He was rushed to Sahyadri Super Speciality Hospital Nagar Road where surgeons immediately assessed the injury and performed emergency microsurgery within the critical time window for successful thumb replantation. The doctors diagnosed the injury as a complex crush and rotational avulsion injury. The force of the accident had severely damaged the blood vessels and nerves in the affected area. This made the procedure far more challenging than a simple severed limb reattachment. As the thumb contributes nearly 40–50% of the hand's overall function, timely intervention was important to maximise the chances of restoring its function and preserving hand mobility.
Speaking about the case, Dr. Sumit Saxena, Consultant Plastic, Reconstructive and Microvascular Surgeon, Sahyadri Super Specialty Hospital Nagar Road, Pune A network hospital of Manipal Hospitals said, "The patient sustained a distal thumb amputation with a crush and rotational avulsion injury, making it significantly more complex than a routine thumb reimplantation. During the five-hour microsurgical procedure, we stabilised the bone, repaired the tendons and meticulously reconstructed the blood vessels and nerves under an operating microscope. Since the arteries and veins had been avulsed and could not be repaired directly despite limited bone shortening, we harvested a vein graft from another part of the body to bridge the defect and restore blood circulation to the thumb. Performing vein grafting at such a distal level, where the vessels are extremely small, is technically demanding and rarely required. Timely intervention played an important role in achieving a successful outcome."
According to a systematic review published in the Journal of Hand Surgery and available through the U.S. National Library of Medicine (PubMed Central), survival rates were significantly higher in clean-cut amputations (92%) than in crush-cut (80%) and crush-avulsion injuries (75%). The findings highlight the added complexity of crush-avulsion injuries, where extensive damage to blood vessels, nerves and surrounding soft tissues often necessitate advanced microsurgical reconstruction, including vein grafting, to restore blood circulation and maximise the chances of successful replantation.
The hospital's reconstructive microsurgery team manages around five to six thumb and finger reimplantation cases annually. While crush-avulsion injuries have lower success rates than clean-cut amputations, the team has successfully performed several complex limb salvage procedures, including arm and bilateral hand reimplantation.