Heterotopic Procedures in Mutilating Hand Injuries

Kokkoli, Effrosyni; Spyropoulou, Georgia‐Alexandra; Shih, Hsin-Nung; Feng, Guan‐Ming; Jeng, Seng‐Feng

doi:10.1097/prs.0000000000001721

Cited by 12 publications

(3 citation statements)

References 58 publications

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“…Their classification scheme is useful in providing a treatment strategy for a given mutilating hand scenario with their treatment preferences encouraging ulnar-sided replantation. Kokkoli et al 12 recently provided a useful synopsis of reconstructive tools describing the heterotopic tools available to the hand surgeon. Although we agree with their sentiment that these injuries are extremely complex, we attempted to provide a more concrete algorithm for surgeons who would encounter this problem frequently.…”

Section: Discussionmentioning

confidence: 99%

“…In such circumstances, heterotopic digital replantation (HDR), temporary ectopic implantation, or toe-to-hand transfer should be considered. 8 9 10 11 12 13 14 15 16 HDR is defined as replacing an amputated digit in a position other than its original anatomical site. As opposed to ODR, HDR is a functional approach to reconstruction rather than anatomical approach to reconstruction.…”

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confidence: 99%

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Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review

Chang

Hsu

Dafydd

et al. 2023

J Reconstr Microsurg

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Background Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital replantation of the available remnants may not adequately restore the hand function. In such cases, heterotopic digital replantation may provide a more functional reconstruction. Methods Between 1997 and 2018, 53 patients with mutilating hand injuries were treated with heterotopic digital replantation at our institution. A retrospective chart review was conducted to determine the details of the injury, indications for heterotopic digital replantation, and functional outcomes. Results In total, 173 digits were amputated from 53 patients (one patient suffered from bilateral hand injuries, so totally 54 hands). Sixty-eight digits underwent heterotopic digital replantation, 30 digits had orthotopic digital replantation, and 75 stumps were terminalized. The survival rate of digits treated by heterotopic digital replantation and orthotopic digital replantation was 83.8% (57/68) and 86.7% (26/30), respectively (p = 1). Tripod grip was achieved in 83.3% (45/54) of patients following replantation and optional secondary reconstructive surgeries. Conclusion Heterotopic digital replantation is a practical and reliable method for achieving optimal hand function following mutilating hand injuries. The basic principles are to restore a functional thumb in the first instance, followed by at least two adjacent fingers against which the thumb can oppose. This method is particularly indicated when orthotopic digital replantation of the available amputated parts would yield a suboptimal result.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review

Chang

Hsu

Dafydd

et al. 2023

J Reconstr Microsurg

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“…When tissue from a donor site is needed for reconstruction, it may be in the form of a single tissue graft or a vascularized composite flap. These operations always involve invading the original site of the body, increasing donor site complications ( 3 ). Surgeons need to compromise between reestablishing the function of an injured limb and the complications of harvesting tissue from an uninjured donor site.…”

Section: Introductionmentioning

confidence: 99%

Transplantation of a free fillet flap from discarded fingers for repair of a finger pulp skin defect: a case report

Zhou,

Zhang,

Fan

et al. 2024

Front. Surg.

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BackgroundReplantation represents a treatment option for patients with severed finger pulps. However, in some cases, replantation is a challenging task.Case presentationWe report a successful case of finger pulp reconstruction of the ring finger using free flaps from a nonreplantable index finger in a spare-parts procedure. A 43-year-old worker accidentally injured the index, middle and ring fingers of his left hand on a machine turntable. The severed index and middle fingers and the distal pulp of the ring finger could not be replanted in situ due to extensive contusion of blood vessels and soft tissues. After vascular and nerve anastomosis, a free skin flap isolated from the nonreplantable index finger was transplanted to the wound of the distal pulpal defect of the ring finger. The flap survived completely postoperatively. Six months after the operation, only a slight deformity of the ring finger was observed. Moreover, sensation of the digit recovered well.ConclusionsSpare-part surgery is a surgical approach that effectively saves and utilizes tissue that would otherwise be discarded in cases of severe limb trauma. This idea may be applied to treatment of severe injuries to multiple fingers. Additionally, in the process of tissue transplantation and repair, attention should be given to protecting the tissue in the recipient area to avoid damage to the original undamaged tissue structure, which can adversely affect healing and recovery of the tissue.

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Classification and clinical evaluation of "spare parts" procedures in mutilating hand injuries

Abdelshaheed

2021

Hand Surgery and Rehabilitation

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Heterotopic Procedures in Mutilating Hand Injuries

Abstract: Therapeutic, IV.

Cited by 12 publications

References 58 publications

Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review

Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review

Transplantation of a free fillet flap from discarded fingers for repair of a finger pulp skin defect: a case report

Classification and clinical evaluation of "spare parts" procedures in mutilating hand injuries

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