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Digital reconstruction in the mutilated hand

W A Morrison, A M MacLeod, B M O'Brien

    Annals of Plastic Surgery
    |November 1, 1982
    PubMed
    Summary
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    Reconstructing mutilated hands and digits is challenging due to a lack of local innervated tissue. Free neurovascular flaps from the foot offer a viable solution for restoring function and sensation.

    Area of Science:

    • Reconstructive surgery
    • Microsurgery
    • Hand surgery

    Background:

    • Reconstruction of mutilated hands and digits is difficult due to local tissue deficits.
    • Innervated pulp tissue is often deficient in severe hand injuries.
    • Existing methods may not provide adequate tissue for complex reconstructions.

    Purpose of the Study:

    • To evaluate the efficacy of free neurovascular flaps from the foot for hand and digit reconstruction.
    • To compare free flaps with conventional methods like the ring-finger island flap.
    • To explore the role of toe transfers in combination with free flaps.

    Main Methods:

    • Utilized free neurovascular flaps harvested from the first web space of the foot.
    • Included toenails in some thumb reconstruction flaps.

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  • Considered finger and whole-toe transfers as reconstructive options.
  • Combined free flaps with other innervated transfers for extensive defects.

    • Main Results:

    • Free neurovascular flaps provide well-padded, innervated glabrous skin for resurfacing defects.
    • Free flaps offer advantages over conventional ring-finger island flaps in thumb reconstruction.
    • Finger and toe transfers, along with free flaps, create a comprehensive reconstructive armamentarium.
    • Sensation in transferred tissues is generally poorer than normal.

    Conclusions:

    • Free neurovascular flaps are effective for reconstructing mutilated hands and digits.
    • Toe and finger transfers, combined with free flaps, provide versatile reconstructive options.
    • The use of these techniques should be considered when adjacent normal tissue is insufficient.