Primary reconstruction with digital ray transposition after resection of malignant tumor

Hand reconstruction after wide resection of digital malignant tumors is still very challenging. The technique of adjacent digital ray transposition has been used for digital defects arising from trauma, but few papers have focused on reconstruction following resection of malignant tumors of the finger. The indications, complications and functional outcomes with this approach are discussed.

Four patients underwent primary reconstruction with adjacent digital ray transposition after tumor resection. Two were men and two were women and the median age was 62 years. The malignant tumors were low-grade chondrosarcomas of the metacarpal bone in two cases, epithelioid sarcoma at the fingertip in one case and synovial sarcoma at the base of the thumb in the fourth case.

Metacarpal osteotomies were rigidly stabilized with a plate and screws and with an intramedullary bone peg graft. Digit length and rotation were satisfactory and there were no non-unions. Local recurrence was not observed at the final follow-up. The mean musculoskeletal tumor society (MTS) score was 60% (range 48-80%). The results of the disabilities of the arm, shoulder and hand score were similar to the MTS score, with a mean score of 35 points (range 22.5-63.5). The worst result was for index-to-thumb transposition and the best was for index-to-middle. All patients experienced emotional difficulty with acceptance of a three-finger hand.

Primary reconstruction with digital ray transposition produces acceptable functional outcomes after resection of malignant tumor. This procedure is best indicated for central single ray amputation but sometimes is associated with esthetical problems.