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Case Reports
. 2022 Mar 21:39:100638.
doi: 10.1016/j.tcr.2022.100638. eCollection 2022 Jun.

Reconstruction of extra-large severe punching hole injury in the palm: A case report

Masakatsu Hihara  1 , Kota Takeji  1 , Toshihito Mitsui  1 , Maako Fujita  1 , Ai Satou  1 , Tomoki Himejima  1 , Natsuko Kakudo  1 , Kenji Kusumoto  1
Affiliations
Case Reports

Reconstruction of extra-large severe punching hole injury in the palm: A case report

Masakatsu Hihara et al. Trauma Case Rep. .

Abstract

A 48-year-old man sustained a severe punching hole injury of 8 cm in diameter on the palm of his left hand using a punching instrument (for making the bottom of drink cans), and his middle and ring fingers were almost amputated. A flow-through type immediate ALT (anterolateral thigh) flap was used to bypass the distal blood flow and a titanium plate for mandibular reconstruction and plantar glabrous skin were used to preserve the floating amputated fingers. As there has been no report of reconstruction of a punching hole in the palmar region that exceeds 8 cm in diameter, this report is novel and educational.

Keywords: Flow-through type ALT flap; Mangled hand; Penetrating wound; Punching hole hand injury; Reconstruction of severe hand injury.

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Conflict of interest statement

The authors declare no conflicts of interest in association with the present study.

Figures

Fig. 1
Fig. 1
Photograph of the machine that caused the injury and the left hand of the patient on arrival at our hospital.
Fig. 2
Fig. 2
A flow-through type immediate ALT flap was harvested and thereafter inserted as a blood flow bypass using the descending branch of LCFA.
Fig. 3
Fig. 3
A plantar glabrous skin graft and mandibular reconstruction with a titanium plate (thickness: 2.5 mm) was used to bridge the phalanx bones and metacarpal bones.
Fig. 4
Fig. 4
The patient achieved a HAND20 score of 54, a Quick DASH score of 29.5, and has returned to his previous position at work.
See this image and copyright information in PMC

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