Vascularized Composite Tissue Spare Part Transfer for Central Hand Defect Reconstruction: Case Report

Area of Science:

• Orthopedic Surgery
• Hand Reconstruction
• Microsurgery

Background:

• Complex hand injuries involving joint, tendon, nerve, and soft tissue loss necessitate advanced reconstructive methods.
• Manual laborers are particularly susceptible to severe hand trauma from industrial machinery.

Observation:

• A manual laborer experienced a severe, multifaceted hand injury from a metal press, resulting in the loss of metacarpophalangeal joints (middle and ring fingers), flexor/extensor tendons, digital nerves, and soft tissues.
• The injury presented a significant challenge for functional and aesthetic restoration.

Findings:

• A 'spare parts' technique was employed, transferring the ring finger's proximal interphalangeal joint as a pedicle graft.
• This graft successfully reconstituted the middle finger's missing metacarpophalangeal joint.
• Ring finger soft tissue was meticulously rearranged for like-to-like reconstruction of glabrous and non-glabrous skin, achieving aesthetic coverage.

Implications:

• This case demonstrates the efficacy of the spare parts technique in complex hand reconstruction.
• Innovative reconstructive strategies can yield favorable functional and aesthetic outcomes in severe hand trauma.
• The findings offer valuable insights for treating similar composite tissue defects in hand surgery.