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Published on: April 26, 2019
Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries
Nai-Jen Chang1, Johnny T Chang, Chung-Chen Hsu
1From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center. Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan; and †Department of Plastic Surgery, Palo Alto Medical Foundation, Palo Alto, CA.
Heterotopic vascularized joint transfer restores hand function after severe injuries. This technique successfully improved prehensile function and range of motion in patients with mutilating hand trauma.
Area of Science:
- Orthopedic Surgery
- Microsurgery
- Hand Reconstruction
Background:
- Mutilating hand injuries pose significant challenges to restoring prehensile function, especially when joints are involved.
- Joint reconstruction or replacement is complex, making salvageable joint transfer a viable option.
- Heterotopic vascularized joint transfer is indicated for functionally optimal repositioning of available joints.
Purpose of the Study:
- To evaluate the efficacy of heterotopic vascularized joint transfer in patients with severe hand injuries.
- To assess the functional recovery, specifically active range of motion and prehensile capabilities, following the procedure.
Main Methods:
- Retrospective analysis of seven patients with severe metacarpophalangeal joint (MPJ) or proximal interphalangeal joint (PIPJ) damage.
- Joints were sourced from non-salvageable amputated digits or proximal stumps.
- Transfers were performed as free flaps with microvascular anastomosis or on neurovascular pedicles; outcomes were analyzed.
Main Results:
- Seven joints were successfully transferred; one was lost due to vasospasm.
- Average active range of motion was 68.3° for homojoint transfers and 35° for heterojoint transfers.
- Six out of seven patients achieved at least tripod pinch, demonstrating significant functional recovery.
Conclusions:
- Heterotopic vascularized joint transfer is a valuable technique for managing mutilating hand injuries.
- Careful surgical planning, execution, and post-operative rehabilitation are crucial for optimal outcomes.
- The procedure can significantly improve prehensile function and overall hand utility.
