Modified “On-Top-Plasty” Technique for Restoring Length to Amputation Stumps

Abstract

Five patients were successfully treated with a modified "on-top-plasty" technique, in which a finger stump is lengthened by transfer of an adjacent amputation stump with a reverse blood flow fingerstump. This technique can be performed in the acute phase or as a secondary procedure. A conventional on-top-plasty can be performed by transfer of a partially amputated index or ring finger to the "top" of the proximal phalanx of an amputated middle finger. Alternatively, the transferred part may be used in an intercalated fashion to reconstruct the middle phalanx, using a prosthesis to reconstruct the proximal interphalangeal joint. The results, complications and disadvantages of the technique are reported. We propose this procedure for the reconstruction of the middle ring finger when a free microneurovascular toe-to-hand transfer is contraindicated or refused by the patient.

Symmetrical peripheral gangrene of all fingers and toes: creating a thumb by on-top plasty in a difficult situation

“…However, sometimes the soft tissue envelope is a limiting factor. Some authors have used a modified technique (Pistre et al, 2002) or a free microvascular transfer (Akin, 2001; Cavadas, 2007) to overcome the relatively constrained pedicle length and the frequent venous congestion. In this case, we overcome the constrained pedicle by shortening the thumb and index metacarpal bones.…”

Reverse On-Top Plasty in Mutilating Hand Injuries

“…6 This concept was also refined to a local vascularized flap that could easily cover soft tissue defect with wider arc of rotation by changing the pivot point. 7 These methods provide recovery of pinch and grip function, but vascular spasm could be a problem at all times because the palmar arch lies near the site of injury. Other modified on-top plasty that include free flap coverage has technical difficulty.…”

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

“…VBGs from the second, third, and first metacarpals have also been described to treat defects of distal radius, scaphoid nonunions, Kienböck's disease, and distal finger reconstruction. [56][57][58] Free Flaps (►Table 2)…”