A 26-year-old man sustains a clean guillotine amputation of his right thumb through the proximal phalanx by a circular saw. He reaches hospital four hours later with the part wrapped in saline gauze on ice. The correct management is:

• A Replantation, because thumb amputation is an absolute indication regardless of level ✓
• B Stump revision and closure, because single digit replantation is never worthwhile
• C Wrap-around free flap from the great toe as the primary procedure
• D Storage of the part in a freezer for possible delayed replantation after one week

Explanation

Amputation of the thumb is an absolute indication for replantation because the thumb contributes roughly half of overall hand function, and loss of even a single thumb justifies the operative effort and morbidity. Clean sharp amputations with short warm ischaemia time carry the best prognosis. Stump revision sacrifices irreplaceable function, and toe transfer is a secondary reconstructive option only when replantation fails or is impossible. Prolonged cold storage beyond safe limits causes tissue necrosis.

Reference: Green's Operative Hand Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.