gms | German Medical Science

58. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

12. - 14.10.2017, München

A truly apocalyptic hand injury... or the difficulty of limb preservation

Meeting Abstract

  • corresponding author presenting/speaker Vanessa Reischenböck - Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Luzern, Switzerland
  • Martina Greminger - Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Luzern, Switzerland
  • Urs Hug - Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Luzern, Switzerland
  • Elmar Fritsche - Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Luzern, Switzerland

Deutsche Gesellschaft für Handchirurgie. 58. Kongress der Deutschen Gesellschaft für Handchirurgie. München, 12.-14.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17dgh097

doi: 10.3205/17dgh097, urn:nbn:de:0183-17dgh0970

Published: October 10, 2017

© 2017 Reischenböck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Thanks to occupational safety guidelines major hand injuries have become a rarity in industrialized countries. This fact has also decreased the exposure of surgeons to severe hand injuries. Furthermore many initial treatments of these injuries are performed in local hospitals and not necessarily by specifically trained hand surgeons. This is why Francisco del Piñal published a classification of various types of injuries of the fingers and hand with appropriate treatment guidelines. On the basis of his article we would like to report a case of a young cheese maker who suffered a severe mutilating hand and forearm injury.

Method: We describe a case of a young man who sustained midcarpal amputation of the non-dominant hand, a complete avulsion of the long fingers, a splitted forearm with extended palmar soft tissue flap, extensive dorsal soft tissue defect with laceration of the extensor muscles and an open ulnar shaft fracture defined as type three according to Gustilo classification.

In the first operation we performed a kind of emergency Vilkki procedure with heterotopic replantation of the thumb and used an anterolateral thigh flap as a free emergency flow through flap. In a second step tendon and nerve reconstruction followed after 4 months. Clinical impression of the injury, operation steps and the functional and aesthetic outcome are well documented by fotos and videos.

Results: Due to surgery, intensive ergotherapy and active cooperation of the patient we accomplished an astonishing good function of the thumb. With the restored grip function the hand can be utilized for many functions in daily life. One year after surgery the patient turned back to work.

Conclusion: To our knowledge this is the first description of a Vilkki procedure done immediately after trauma. This report demonstrates, that even in case of a most terrific mutilated hand, it is crucial and feasible to set the foundation for a reconstruction as best as possible to achieve an "acceptable hand" according to the classification published by Francisco del Piñal.