An innovative approach to functional reconstruction of destructively dismembered hands by swapping the tissue of left and right: a case report
10.3760/cma.j.cn441206-20240521-00126
- VernacularTitle:双手严重毁损功能重建的创新方法：左侧、右侧组织互换再造1例
- Author:
Jiyong JIANG
1
;
Tian YU
;
Yuzhi YU
;
Rongyu LAN
;
Long TU
;
Dong HUANG
;
Yi YANG
Author Information
1. 广州和平骨科医院创伤显微外科，广州 510315
- Publication Type:Journal Article
- Keywords:
Replantation of amputated limb;
Ectopic replantation;
Hand reconstruction;
Perforator flap;
Reconstruction
- From:
Chinese Journal of Microsurgery
2024;47(6):702-705
- CountryChina
- Language:Chinese
-
Abstract:
In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.
