Functional salvage of a hand after unsuccessfull attempt of replantation

Abstract

Amputation by crush injuries generally represents a contraindication for replantation, and especially when the lesion is caused by the summation of multiple concomitant traumatic mechanisms. We present the case of a 22 year- old female who arrived in our service with a crush/torsion amputation of all long fingers at the metacarpo-phalangeal level of the right hand. After the unsuccessful attempt of replantation, the functional reconstruction of the hand was achieved by using a double free flap transfer: anterolateral thigh perforator flap (ALT) and digital block transfer of second and third toes.

Keywords: amputation; double free flap transfer; flow-through flap; necrosis; replantation.

Figure 1

preoperative aspect showing the large crushed area and the torsion of the amputated part.

Figure 2

Necrosis of the replanted segment.

Figure 3

Aspect of the hand after necrectomy and granulation.

Figure 4

Harvesting of the antero-lateral thigh perforator flap.

Figure 5

Harvesting of the digital block of second and third toes.

Figure 6

Immediate postoperative aspect.

Figure 7

One year postoperative aspect, showing the good functional rehabilitation.

Figure 8

One year postoperative aspect, showing the good functional rehabilitation.

Figure 9

One year postoperative aspect, showing the good functional rehabilitation.