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Elective cross-hand transfer: a case report with a five-year follow-up
J W May1, D M Rothkopf, R C Savage
1Department of General Surgery, Massachusetts General Hospital, Boston 02114.
The Journal of Hand Surgery
|January 1, 1989
Summary
This study reports the first elective free microvascular cross-hand transfer, successfully restoring function to a photographer's left hand using their right hand. The procedure involved tendon transfers and nerve grafting, resulting in useful flexion and extension five years post-operation.
Area of Science:
- Hand surgery
- Microsurgery
- Reconstructive surgery
Background:
- A 35-year-old professional photographer experienced traumatic left hand amputation with thumb preservation.
- A concurrent right upper extremity injury resulted in a paralyzed and insensate right hand with thumb amputation due to brachial plexus palsy.
Observation:
- The patient underwent an elective free microvascular cross-hand transfer, reattaching the right hand to the left distal carpus.
- The reconstruction involved immediate tendon transfers and primary nerve grafting to restore function.
Findings:
- The procedure successfully restored finger flexion and extension, along with functional sensibility in the reconstructed left hand.
- Five-year follow-up confirmed useful and powerful digital flexion and functional extension.
- Improved right upper extremity function was achieved with a below-elbow prosthesis.
Implications:
- This case demonstrates the feasibility and long-term efficacy of elective free microvascular cross-hand transfer for severe hand reconstruction.
- The technique offers a viable solution for patients with extensive hand and upper extremity trauma, improving quality of life.
- Further research can explore optimizing surgical techniques and patient selection for similar complex reconstructions.