Selective finger transposition and primary metacarpal ray resection in multidigit amputations of the hand

In multidigit amputations parts with the most favorable prognosis (cleaner amputation, less crushed, short ischemia time) can be "selectively" replanted in positions most appropriate to providing useful function and cosmetic acceptability, regardless of their anatomic origin. Digits with poor prognosis are not reattached. These principles are applied in four selected cases involving multidigit amputations proximal to the proximal interphalangeal joints in which the least traumatized digits were selectively joined to the more ulnar metacarpal rays; intervening metacarpal shafts were primarily resected to clear the first web space of obstructing bony stumps. The narrowed palmar arch, although weaker, achieves wider palmar span grasp. Fingers in contiguity, although fewer in number, allow improved precision handling, chuck pinch, and cosmetic acceptability.