Reconstruction of absent fingers and hands

Abstract

The author described his personal experiences for more than 30 years in treating absent fingers and/or hands due to congenital condition or trauma. His initial interest in this subject was aroused by the thalidomide incident occurred in Japan around 1960, when he encountered many children with the tragic thalidomide embryopathy. In the first part of the paper, he described his experience in the research and development of electric arms. He obtained an opportunity visiting the Pediatric Amputee Clinic at Michigan Crippled Children Commission (MCCC) in Grand Rapids headed by late Dr. G. T. Aitken and Dr. C. Frantz in 1968. This prompted him to organize a study group to develop electric arms for the thalidomide victims in Japan responding a big social demand to create a reasonable artificial arm for them. He and his group developed arms with three-degree of freedom (motion) incorporated with a microcomputer system. But its heavy weight, weak power and complicated mechanism prevented the children from daily and practical use of the arm. Frankly, the author and his group ended up only to realize the extreme difficulty in simulating a living human arm and hand. In the second part of the paper, the author described surgical managements for absent fingers and/or hands, demonstrating the photographs of his own cases. The reconstructive methods included digital transfer, toe transplantation, bone lengthening, digital reconstruction, interdigitation and Krukenberg procedure. Digital transfer was especially useful for the total thumb defect. Microvascular toe transfer using the second toe was successful in a child with monodactylic form of symbrachydactylia. Sometimes, thumb reconstruction with a wrap-around flap from a big toe yielded a good cosmetic and functional result. He also described reconstruction of floating thumbs with iliac bone grafting and/or vascularized metatarsophalangeal joint transplantation associated with an abdominal flap. As for the bone lengthening procedure, he mentioned that recent knowledge in callotasis improved the results and expanded its indications. Finally for long forearm amputees, especially bilateral ones, he mentioned that the value of Krukenberg procedure still exists in view of its good postoperative functional capacity.