Reconstructive strategy for primary repair of injuries of the hand and fingers

Abstract

Objective To explore the strategy and clinical effects of primary reconstruction of severe injuries of the hand and fingers.Methods From July 2006 to May 2012,37 cases with severe injuries of the hand were treated with different microsurgical reconstructive strategies.Three types were identified on account of the severity of the injury.Type A involved multiple finger loss only and was treated with 2 to 4 toes transfer for finger reconstruction (22 cases).Type B involved large area of soft tissue defect only and was repaired by instep island flap and medial plantar island flap transfer (6 cases).Type C involved simultaneous defects of palm of the hand and fingers and required reconstruction using second toe transfer along with instep island flap and medial plantar island flap in 6 cases and reconstruction of palm of the hand with scapular flap and reconstruction of fingers with toe transfers in 3 cases.Results All the transplants in the 37 cases survived.Vascular crisis occurred in 3 cases but was reversed with surgical exploration and intervention.Postoperative follow-up ranged from 8 months to 2 years.The appearance and function of the hands was satisfactory.Comprehensive evaluation based on the extent of the lesions showed an increase of hand function from 35％ to 75％ (average 40％).The surgical reconstruction significantly improved hand function.Conclusion Application of different reconstruction methods based on the severity of hand injuries can achieve successful primary reconstruction the hand and fingers. Key words: Hand injuries; Microsurgery; Repair and reconstruction; Rebuild