Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries

Chang, Nai-Jen; Chang, Jonathan; Hsu, Chung-Chen; Lin, Chih-Hung; Lin, Chih‐Hung; Lin, Yu‐Te

doi:10.1097/sap.0000000000000712

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…Vascularized MCPJ transfers can be harvested from spare non-replantable fingers (homodigital or heterodigital) or the metatarsophalangeal joint (MTPJ) and includes concurrent transplantation of the associated ligaments, bones, capsule, and overlying skin with satisfactory outcomes [ 6 , 7 ]. Pedicle-based vascular joint transplants avoid the time and technical burden of microsurgical anastomosis compared to free joint transplants but still require meticulous dissection and may not always be anatomically available [ 5 , 8 ]. Long-term outcomes are better in complete joint compared to hemi-joint transplants due to better cartilage preservation, synovial safeguarding, and avoidance of incongruent joint surfaces and are preferred if obtainable [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our patient, utilization of the middle finger metacarpophalangeal osteochondral remnant and the DIP joint were used to reconstruct the MCPJ of both the thumb and index, respectively. Though non-vascularized joint transfers carry a higher risk of deterioration and avascular necrosis, they can be an effective reconstructive option with good outcomes and patients may remain asymptomatic despite radiologic evidence of degeneration [ 5 , 8 ]. In the present case, the patient continues to demonstrate satisfactory outcomes six years following her injury.…”

Section: Discussionmentioning

confidence: 99%

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

Patel,

Özyurekoglu

2024

Cureus

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We report our management of a 53-year-old female who suffered a wood planer hand-mutilating injury with significant dorsal soft tissue loss and partial metacarpophalangeal joint (MCPJ) amputations of the thumb, index, and middle fingers. The middle finger was deconstructed for “spare parts” and a vascularized osteochondral graft was utilized to reconstruct the metacarpal articular surface of the index finger proximal phalanx, allowing the pedicled transposition of the index finger to the third metacarpal. The middle finger's distal interphalangeal joint was transplanted non-vascularly to recreate the thumb MCPJ and the elevation of a middle finger fillet flap allowed dorsal wound coverage. The patient did well initially but required ulnar collateral ligament reconstruction with a palmaris longus tendon graft following MCPJ instability 10 months postoperatively. Nonetheless, she progressively regained thumb opposition and pinch grip and continues to have successful aesthetic and functional outcomes six years postoperatively, supporting the efficacy of non-vascularized joint transfers when vascularized options are superfluous or unavailable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Patel,

Özyurekoglu

2024

Cureus

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“… 22 It may even be possible to design a small free flap or vascularized joint transfer to improve function. 23 More extensive injuries, such as skin and soft tissue defects, tendon loss, and proximal neurovascular injuries may require reconstruction and immediate soft tissue cover. Flaps, either distant or free, have advantages and disadvantages.…”

Section: Discussionmentioning

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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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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“…[ 1 ] Reconstruction and restoration of function following mutilating hand injury poses a severe challenge to the reconstructive surgeon. [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps

Cui

Maharjan

et al. 2016

Medicine

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Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries

Abstract: Heterotopic vascularized joint transfer is a useful technique to consider in cases of mutilating hand injuries. Improved recovery of prehensile function can be achieved with thoughtful design and execution, followed by proper patient education and rehabilitation.

Cited by 7 publications

References 20 publications

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

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

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

Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps

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