A preliminary study on the classification of mutilated injuries of the radial side of the hand

Abstract

Objective To investigate the classification of mutilated injuries of the radial side of the hand and the clinical outcomes of primary repair. Method A retrospective study of 129 cases of mutilated injuries of the radial side of the hand was carried out. The injuries were divided into five types. In type Ⅰ the mutilated injury only involved the thumb (54 cases). In type Ⅱ the mutilated thumb was accompanied by skin defect of the first web space (33 cases). In type Ⅲ both the thumb and index finger were mutilated along with skin defect of the first web space ( 10 cases). Type Ⅳ involved mutilated injuries of the thumb, index finger and long finger,and skin defect of the first web space (29 cases). In Type Ⅴ the mutilated injuries involved the thumb, index finger, long finger and the radial side of the palm, along with skin defect of the first web space (3 cases).According to the different injury types, various reconstruction strategies were used including toe-to-thumb transfer or heterotopic replantation of the remaining finger for thumb reconstruction, anterolateral thigh flap, dorsalis pedis flap or lateral arm flap for resurfacing of the radial side of the hand. Results Out of the total 129 cases, the transferred flaps and toes or heterotopically replanted fingers in 128 cases survived. The overall survival rate was 99.2%. The patients were follow-up for 1 to 4 years. According to the provisional functional assessment criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the functional recovery was rated as excellent in 46 cases, good in 61 cases, acceptable in 19 cases, and poor in 3 cases. The overall excellent and good rate was 82.9%. Conclusion Classification of mutilated injuries of the radial side of the hand is useful for the selection of proper operative procedures. The clinical outcome is satisfactory after functional reconstruction with primary repair. Key words: Hand; Wounds and injuries; Reconstructive surgical procedures; Typing