gms | German Medical Science

Objectives: In complex hand injuries, the functional results depend on bone and soft tissue reconstruction. Sometimes, parts of otherwise not salvageable fingers can be used to reconstruct other defects.

Method: In our case, a 39-year old farmer suffered a circular saw injury with open fractures of the 3 ulnar sided fingers of his left hand. The entire small finger was precisely longitudinally cut into two halves, thereby destroying the middle phalanx and tendons, but sparing vessels and nerves, leaving two viable flaps. Longfinger and ringfinger suffered ulnar-sided open defect-fractures of the DIP-joints which stabilized by percutaneous temporary DIP-joint arthrodesis. The soft tissue defects around those DIP-joints were covered by using the small finger as spare finger. For this purpose the small finger was exarticulated in the MP-joint resulting into the above-mentioned filet flaps. Forming two pedicled tubular flaps out of them, the DIP-joints of the neighboring fingers could be covered. Pedicle division was carried out after 3 weeks, the k-wires were extracted after 6 weeks.

Results: Exactly 2 months after the injury, the patient came back to work as farmer. After 3 months, the main residual functional restraint was a 20% mobilty-restriction of the remaining fingers, mainly located in the fractured DIP-joints.

Conclusion: Treatment of complex hand injuries benefit from the combination of orthopedic and plastic surgical principals. Seemingly old-fashioned techniques should be kept in mind.