Algorithm-Guided Management of Thumb Amputation: A 20-Year Retrospective Review and Outcome Analysis

<b>Background:</b> The thumb accounts for 40-50% of hand function. Traumatic amputation of the thumb results in significant disability and necessitates a structured approach to management. <b>Methods:</b> We conducted a retrospective review of 144 patients treated for thumb amputations between 2004 and 2025 at a specialist hand surgery unit. Over 21 years, an institutional algorithm was developed and refined to guide treatment decisions based on amputation level, injury mechanism and patient factors. <b>Results:</b> Out of the 144 cases, 118 patients underwent replantation, achieving an 82% success rate. Alternative reconstructive procedures included toe-to-thumb transfers (eight cases), index finger pollicisation (six cases) and fourth finger pollicisation (five cases). Functional outcomes showed that 90% of patients returned to work, 83% regained temperature and touch sensation, and 94% could lift a 0.5 L bottle. <b>Conclusions:</b> Implementing a structured treatment algorithm facilitates personalised care and leads to favourable functional outcomes in patients with traumatic thumb amputations.