Algorithmic surgical enhancement of function after finger revascularisation.

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Microsurgery

Background:

• Revascularization and replantation of digits are critical for restoring function after severe trauma.
• Secondary surgical procedures are often necessary to optimize outcomes in complex cases.
• Flexor tendon injuries in Zone II present significant reconstructive challenges.

Observation:

• A patient sustained a saw injury involving multiple digits at flexor tendon Zone II.
• The patient underwent initial multidigit revascularization and replantation.
• A subsequent staged reconstructive protocol was implemented to maximize functional recovery.

Findings:

• The reconstructive sequence included late revascularization, nerve reconstruction, vascularized joint transfer, staged flexor tendon reconstruction, and skin revision.
• This tailored, staged approach ensured patient safety throughout the secondary procedures.
• The patient experienced a significant functional improvement, with a 45-point increase in the Disabilities of the Arm, Hand, and Shoulder (DASH) questionnaire score.

Implications:

• A systematic, staged secondary surgical approach can significantly enhance functional outcomes after complex digit revascularization and replantation.
• This reconstructive strategy allows for a near-complete range of motion and return to work.
• The described decision procedure offers a valuable framework for managing challenging hand reconstructions.