Multiple Free Flaps and Second Toe Transfer to Salvage Grasp Function in Bilateral Complete Degloved Hands.

Area of Science:

• Reconstructive Microsurgery
• Hand Surgery
• Orthoplastic Surgery

Background:

• Severe hand trauma, including degloving injuries and multiple digital amputations, presents significant reconstructive challenges.
• Restoration of thumb length and hand coverage is crucial for functional recovery and patient independence.

Observation:

• A 21-year-old male laborer experienced bilateral hand degloving injuries with extensive digital amputations.
• Initial management involved debridement and completion of amputations, including bilateral index ray amputations.

Findings:

• Two anterolateral thigh (ALT) flaps and one second toe transfer were used for initial reconstruction, providing coverage and thumb reconstruction on the right side.
• A subsequent staged reconstruction involved a second toe transfer with a dorsalis pedis flap for the left thumb and a gracilis flap for donor site closure.
• Two-year follow-up demonstrated functional hands with adequate power grasp, pinch grip, and dexterity for independent living.

Implications:

• Complex, staged microsurgical reconstructions utilizing toe-to-hand transfers and free flaps can effectively restore function after severe hand trauma.
• Successful reconstruction enables patients to regain independence and improve their quality of life despite extensive digit loss.