Abstract
in frostbite patients. Material and methods Medical histories and long-term results of treatment of two frostbite patients with finger stumps of both hands were reviewed. The triphalangeal finger and the thumb were reconstructed by transplanting the opposable finger stump together with the metacarpophalangeal joint using microvascular and microneural anastomoses. The stumps were mobilized and transplanted to the distal ulnar artery with the venous drainage performed using the dorsal saphenous vein of the hand. Long-term results were examined at 10 years and 2.5 years of surgery. Clinical, radiological, biomechanical and biophysical investigations were produced. Results The bilateral gripping function was restored in recipient stumps without functional damage to the donor stumps. Discriminatory sensitivity of reconstructed fingers was 6mm and 8 mm, the range of active motion in the transplanted joint was 55 and 66 degrees. Discussion Opposable digital stump transplantation with microvascular anastomoses has significant advantages over the classical surgery. The technique allows for one-stage restoration of a finger to have sufficient length, function, adequate blood supply and innervation due to a short digital stump being transplanted with the metacarpophalangeal joint. The advantage over a toe transplant consists of the use of digital structures of the hand that are identical in functionality and the anatomy reducing the need for secondary interventions. Conclusion The method of management can be successfully applied for frostbite patients with hand stumps according to indications.
Highlights
Toe transplantation by microvascular anastomosis is one of the major methods of finger reconstruction used for congenital pathology and consequences of mechanical trauma [1–6]
Transplantation of a full length finger of the contralateral hand is rare in frostbite due to the finger stumps in both hands, and one of a finger stump can be transplanted
The objective was to explore possibilities with reconstruction of opposable digital stump of the hand transplanted with microvascular anastomoses in frostbite patients
Summary
Toe transplantation by microvascular anastomosis is one of the major methods of finger reconstruction used for congenital pathology and consequences of mechanical trauma [1–6]. Patients who have suffered frostbite often have stumps of the toes and feet that significantly limit the potential of the methoda and relevant donor resources of the contralateral hand are essential. In comparison with the transplantation of the toe or its segments, the transplantation of tissue complexes of the contralateral hand for finger reconstruction is occasionally used for mechanical and cold-induced injuries [8]. Possibilities with the method, technical and strategical approaches to the interventions depending on the functional state of the vessels, a defect type and the level of finger and hand stumps have been underexplored. Few cases with non-cold injuries treated with the method of digital transplantation are reported without description of the surgical technique [9–11]
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