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A complete dislocation of the proximal phalanx of the thumb is presented. At 6 months after the injury, the patient had a painless right thumb with a full range of motion. No such similar case has been found in the literature.
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Three fingers have been reimplanted at present, bij means of microsutures of digital arteries and veins. The help of the surgical microscope is essential to this technique. In case of traumatic amputation of many fingers, with a neat minimal section, the chances of success are particularly good with a low risk of infection.
Improvement in the function and appearance of hand brought about by using tissue from a damaged index finger is presented. The damaged index finger could have been retained as a stiff digit or thrown away in the bucket.
Up to now the succes rates in replantation surgery which are reported in the literature do not include the functional results. To compare the final functional results it is necessary to have a common international classification of what is a complete amputation and what is a incomplete one. It is then important to compare only similar subtotal amputations. In this paper we suggest a definition and classification of amputations in the upper extremity in the following way: type I....bone type II....extensor tendons type III....flexor tendons type IV....palmar digital nerves type V....skin A subtotal amputation will intakt flexor and extensor tendons as well as palmar nerves should be classified as "type II, III. IV".
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Reconstruction of a severely damaged hand, with multiple amputations of digits, presents a difficult reconstructive problem. The development of a safe method of transfer of the great toe for thumb reconstruction, using the dorsalis pedis artery and the saphenous vein, suggested the possibility of one-stage microvascular transfer of the second toe for reconstruction of fingers. In two patients a one-stage transfer of the second toe was done to replace an index finger and in another for restoration of part of the left ring finger. The transplants survived without anticoagulants and vessel complications were not encountered. Sensory return was adequate and a significant improvement in function was achieved.
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Replantation of a circularly severed palm, partially severed middle finger and completely severed ring and small fingers was done successfully in one patient. Two palmar arteries, 5 digital arteries, 3 dorsal palmar veins, 9 dorsal digital veins were anastomosed. Vein transplantation was carried out to repair the ulnar digital artery defect of the middle finger. Severe swelling after arterial thrombosis was noted on the 7th day and was eliminated by the use of urokinase. All the replanted parts survived with good functional results. Precise anastomosis, prevention and treatment of thrombosis, early exercises were essential to the survival of fingers and functional recovery of hand.
This page reports our experience of 423 digital and hand replantation over the period of 35 months. A classification based on the levels of amputation is suggested. The operative technique and indication of replantation are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.