Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/0970-0358.191313
Algorithmic surgical enhancement of function after finger revascularisation
Publication History
Publication Date:
13 August 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042863/201602/lookinside/thumbnails/10-4103-0970-0358-191313_00239-1.jpg)
ABSTRACT
Secondary surgical procedures can improve the function of revascularised and replanted digits. We describe the case of a patient who underwent multidigit revascularisation and replantation following a saw injury at flexor tendon Zone II. To achieve maximal functional improvement after finger revascularisation, we performed secondary surgical procedures in an order that was determined by following a reconstructive decision procedure that covered late revascularisation, nerve reconstruction, pedicled vascularised joint transfer, staged flexor tendon reconstruction and skin revision. Performing the procedures in this manner ensured overall safety. The patient’s disabilities of the arm, hand and shoulder questionnaire score improved by 45 points, and the patient was able to return to work with an almost complete range of motion.
-
REFERENCES
- 1 Venkatramani H, Sabapathy SR. Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations. Indian J Plast Surg 2011; 44: 237-45
- 2 Sabapathy SR, Venkatramani H, Bharathi RR, Bhardwaj P. Replantation surgery. J Hand Surg Am 2011; 36: 1104-10
- 3 Sabapathy SR, Venkatramani H, Bharathi RR, Sebastin SJ. Distal fingertip replantation without skeletal fixation. J Reconstr Microsurg 2005; 21: 11-3
- 4 Wang H, Oswald T, Lineaweaver W. Secondary surgery following replantation. In: Weinzweig N, Weinzweig J. editors. The Mutilated Hand. Philadelphia: Elservier; 2005: p. 247-64
- 5 Hussl H, Jungwirth W, Hasenöhrl K. Microsurgery for cold intolerance after finger replantation. Lancet 1989; 2: 690
- 6 Taras JS, Hankins SM, Mastella DJ. Staged Flexor Tendon and Pulley Reconstruction. Philadelphia: Lippicontt Williams & Wilkins; 2005
- 7 Thomas AG. Unfavorable results in replantation. Indian J Plast Surg 2013; 46: 256-64
- 8 Alphonsus CK. Principles in the management of a mangled hand. Indian J Plast Surg 2011; 44: 219-26
- 9 Weinzweig N, Sharzer LA, Starker I. Replantation and revascularization at the transmetacarpal level: Long-term functional results. J Hand Surg Am 1996; 21: 877-83
- 10 Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 2001; 14: 128-46
- 11 Hunter JM, Salisbury RE. Flexor-tendon reconstruction in severely damaged hands A two-stage procedure using a silicone-dacron reinforced gliding prosthesis prior to tendon grafting. J Bone Joint Surg Am 1971; 53: 829-58
- 12 Yu JC, Shieh SJ, Lee JW, Hsu HY, Chiu HY. Secondary procedures following digital replantation and revascularisation. Br J Plast Surg 2003; 56: 125-8
- 13 Buntic RF, Buncke HJ, Kind GM, Chin BT, Ruebeck D, Buncke GM. The harvest and clinical application of the superficial peroneal sensory nerve for grafting motor and sensory nerve defects. Plast Reconstr Surg 2002; 109: 145-51
- 14 Wang H. Secondary surgery after digit replantation: Its incidence and sequence. Microsurgery 2002; 22: 57-61
- 15 Squitieri L, Chung KC. A systematic review of outcomes and complications of vascularized toe joint transfer, silicone arthroplasty, and Pyrocarbon arthroplasty for posttraumatic joint reconstruction of the finger. Plast Reconstr Surg 2008; 121: 1697-707
- 16 Cavadas PC, Landin L, Thione A. Reconstruction of the condyles of the proximal phalanx with osteochondral grafts from the ulnar base of the little finger metacarpal. J Hand Surg Am 2010; 35: 1275-81
- 17 Foucher G, Hoang P, Citron N, Merle M, Dury M. Joint reconstruction following trauma: Comparison of microsurgical transfer and conventional methods: A report of 61 cases. J Hand Surg Br 1986; 11: 388-93