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Surgical Opportunism for Hand Reconstruction Following a Mutilating Injury: A Case Report.

Krishna A Patel1, Tuna Özyurekoglu2

  • 1Surgery, OhioHealth Riverside Methodist Hospital, Columbus, USA.

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|August 5, 2024
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Summary

This case study demonstrates successful hand reconstruction using non-vascularized joint transfers for severe finger amputations. The innovative technique restored thumb opposition and pinch grip, highlighting its efficacy in complex hand injuries.

Keywords:
fillet finger flapfree joint graftmetacarpophalangeal joint reconstructionnon-vascularized joint transferpedicled finger transferspare parts

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Area of Science:

  • Hand surgery
  • Microsurgery
  • Reconstructive surgery

Background:

  • Severe hand injuries often require complex reconstructive strategies.
  • Metacarpophalangeal joint (MCPJ) amputations present significant functional challenges.

Observation:

  • A 53-year-old female sustained a severe hand-mutilating injury with partial MCPJ amputations of the thumb, index, and middle fingers.
  • The management involved deconstruction of the middle finger for tissue, reconstruction of the index finger's metacarpal articular surface with a vascularized osteochondral graft, and non-vascularized transfer of the distal interphalangeal joint to recreate the thumb MCPJ.

Findings:

  • The patient underwent successful pedicled transposition of the index finger and non-vascularized joint transfer for thumb reconstruction.
  • Initial recovery was good, though ulnar collateral ligament reconstruction was needed 10 months postoperatively due to MCPJ instability.
  • Long-term outcomes at six years showed regained thumb opposition and pinch grip with successful aesthetic and functional results.

Implications:

  • Non-vascularized joint transfers are a viable and effective option for specific complex hand reconstructions.
  • This approach offers a valuable alternative when vascularized options are not feasible or necessary.
  • The study supports the efficacy of these techniques in restoring function after severe hand trauma.