Digit revascularization in patient with congenital monodactyly: expanding indications for salvage

Abstract Management of partial and complete digit amputations is guided by injury characteristics, patient comorbidities, and functional prognosis; however, congenital hand differences and disability remain underexplored in current literature. We present a 47-year-old congenitally blind patient with tetramelic monodactyly who sustained a near-complete zone II amputation of his only left digit following a dog bite, with associated metacarpal head destruction. Despite relative contraindication conferred by the mechanism of injury, the patient had profound reliance on his digit for independence; as such, emergent revascularization was performed via metacarpophalangeal joint (MCPJ) arthrodesis and repair of a single digital artery and nerve. Venous outflow was facilitated by topical heparin-soaked pledgets and acetylsalicylic acid. At five months, the patient demonstrated meaningful MCPJ motion, sensory restoration, and return to activities of daily living. This case highlights the critical role of patient-centered social factors and reconstructive principles in surgical decision-making when established prognostic frameworks offer limited guidance.