gms | German Medical Science

Objectives/Interrogation: We report our method of free vascularized tissue transfers to repair mutilated hands with multiple finger destructions.

Methods: From August 2016 to April 2018, we treated 6 patients with multiple finger destructions and severe tissue trauma of the hand using free flap transfers. Three hands had amputation through their MP joints of index to little fingers with soft tissue defects of the dorsal hands. These hands were repaired with free groin flap or a venous flap. The flaps were used as flow-through flaps, which connected distally to the digital arteries or dorsal veins for replanting amputated fingers. Two patients had incomplete amputation of two fingers and multiple fractures and dislocations of other fingers. After reduction and fixation of the fractures and joints, lobed anterolateral thigh flaps were transferred to cover soft tissue defects palmarly and dorsally, with revascularization of the incompletely amputated fingers. The more recent case with skin avulsion of palm and dorsal hand, and destruction of vascular circulation in 5 fingers. The hand was repaired with an anterolateral thigh flap with multiple vein grafting for revascularization of 5 fingers. All the cases were treated by heparin over the first 7 days after surgery.

Results and Conclusions: All the fingers survived except postoperative artery crisis happened in one patient and was rescued by surgical exploration and re-anastomosis. The soft tissue coverage is sufficient and all fingers survived after replantation or revascularization. The hand with a venous flap transfer had obvious scar contracture. That patient required scar excision and finger joint release and a groin flap transfer 6 months after initial surgery.

Reconstruction of multiple finger destructions accompanied with soft tissue defects in the hand is challenging. We show here that vascularized flap transfer to repair tissue loss in the dorsal or palm of the hand together with distal anastomosis of the vessels to digital artery and veins of amputated fingers can salvage both amputated fingers and severely traumatized hand with extensive tissue losses. We have used end-to-end or end-to-side anastomosis for the flap transfer or finger revascularization distally. The design of the combined transfer or ideal connection of vessels is a key to success of surgical salvage, which should be decided according to intraoperative findings and availability of vessels in these severely traumatized hands.