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

Abstract

Mutilating hand injuries are common, and reconstruction should be tailored to each case. The “spare parts” concept relies on harvesting tissues for reconstruction from amputated or non-salvageable parts that are being discarded. This study sought to evaluate the outcomes of “spare parts” procedures in mutilating hand injuries and to propose a classification of “spare parts” types. This study included 28 patients with mutilating hand injuries undergoing surgery using “spare parts” for tissue reconstruction either at the time of trauma or later on. A total of 31 “spare parts” procedures were performed on the 28 patients. The outcomes were assessed in terms of reconstruction success, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, and an overall patient satisfaction score that we designed. Reconstruction using “spare parts” was successful in 25 patients (89%). The mean DASH score was 8.45 ± 4.74, the mean grip strength was 24.57 ± 2.73 kg, and overall patient satisfaction was 3.32 ± 0.77 out of 5. Specific outcomes were assessed using case-specific measures. Based on these data, a hand-specific classification of “spare parts” procedures was designed to be taken into consideration when managing mutilating hand injuries. Besides direct digital replantation and tissue harvesting from different donor sites, the “spare parts” concept is an important tool for a hand surgeon. Its different types should always be taken into consideration when managing mutilating hand injuries to avoid additional donor site morbidities and to achieve a high level of overall patient satisfaction. We propose adding a “patient satisfaction with hand appearance” item to the DASH and QuickDASH score.