A technique of hand digit reconstruction using scarred and deformed donor segments

Hand digit reconstruction with transposition of hand segments in cases of hand injury is not used frequently by surgeons, at least in part because of potential ischemic complications after cicatricial changes in tissues. The aim of this study was to investigate the opportunities for expanding the set of indications for hand digit reconstruction using scarred and deformed donor segments.

We developed a technique of ischemic preconditioning and preforming the segment before transfer to improve macro-circulation and micro-circulation in scarred donor segments with a view to preventing ischemic complications in reconstructed digits. It was validated using clinical, radiological, morphological, and biophysical (IR imaging, laser Doppler flowmetry, rheovasography) methods.

A total of 184 patients were included. Primary digit reconstruction was performed in 19 patients while secondary reconstruction-in 165 patients. Single-stage transfer was performed in 122 hands, delayed transfer-in 67 hands. The total number of reconstructed thumbs and fingers was 203. Digit viability, stability, mobility and range of motion were very good with the use of new technique.

When transferring hand segments with severe and highly severe deformations, tissue scarring and vascular damage, it is beneficial to pre-train the donor segment against hypoxia by both exsanguination and surgical methods.