gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Spare-part surgery for reconstructing a basic hand function

Meeting Abstract

  • presenting/speaker Alperen Bingöl - Hannover Medical School, Hannover, Germany
  • Tobias Mett - Hannover Medical School, Hannover, Germany
  • Ramin Ipaktchi - Hannover Medical School, Hannover, Germany
  • Andreas Jokuszies - Hannover Medical School, Hannover, Germany
  • Nicco Krezdorn - Hannover Medical School, Hannover, Germany
  • Peter Vogt - Hannover Medical School, Hannover, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1519

doi: 10.3205/19ifssh1102, urn:nbn:de:0183-19ifssh11029

Veröffentlicht: 6. Februar 2020

© 2020 Bingöl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: Spare-spart surgery became widely known and recognized in the reconstruction of extremities after devastating injuries or illnesses. Despite the mutilating character of the surgical procedures, they still are of big importance. Sometimes they offer the surgeon and the patients an option for reconstructing basic functions. Because of the absence of standardized techniques, the surgical therapy must be customized for the patients. With this case we present a reconstruction of key grip hand function by using spare-part surgery.

Methods: Necrosis of both feet, the left forearm and the distal part of the right hand occurred in a patient due to high-dose catecholamine therapy and septic thrombo-embolization. We used the lower leg as a free osteocutaneous flap to reconstruct a basic hand function after amputation of nearly all extremities.

Parts of the fibula were located alongside the remaining first metacarpal bone. Osteovascular on top-plasties were performed by docking two of the metacarpal stumps onto the remaining two metacarpals. Due to thrombosis of the princeps pollicis artery, a venous interposition graft from the right forearm was dissected and used. Furthermore, the flap was microsurgically anastomosed end-to-side to the ulnar artery which was the only remaining arterial supply to the hand. The size of the buried fibula was reduced to the necessary thumb length and fixed to the metacarpal I stump in a next step. Secondary procedures like z-plasties were performed optimize the results.

Results and Conclusions: After all the surgical procedures and fitting of the necessary prosthesis, the patient is now able to manage most of the daily life. The patient can grasp objects and even write, after fixing a pen in the first webspace.

This is the first description of successful microvascular transfer of a wrap-around type osteocutaneous free flap from an amputated lower leg to our knowledge.

This technique might be useful in similar cases in the future.