Reconstruction of mutilating hand injuries by microsurgical free tissue transfers from the foot
- Ayaktan ele serbest doku nakli yöntemleri, parçalanmış el yaralanmalarında %95'in üzerinde başarı oranıyla fonksiyonel sonuçlar sağlamaktadır.
- Mikrocerrahi teknikler sayesinde tek seansta birden fazla parmak ve eklem transferi yapılarak hastaların %88,7'sinin iş hayatına geri dönmesi mümkün olmaktadır.
- Başarılı bir rekonstrüksiyon için dorsal ve plantar arter sistemlerinin hassas planlanması ve kombine doku transferlerinin kullanılması kritik öneme sahiptir.
İçerik yapay zeka ile optimize edilmiştir
Mutilating Hand Injuries and Advanced Reconstruction Methods
Mutilating hand injuries represent some of the most challenging cases in reconstructive surgery. The primary objective of this study is to present various hand reconstruction methods and provide critical technical notes regarding the treatment of these injuries using free-tissue transfers from the foot. Furthermore, the research investigates whether these complex transfers successfully provide patients with a functional and usable hand.
Patients and Research Methodology
The study included 90 patients suffering from mutilating hand injuries, involving a total of 101 surgical procedures. To evaluate the long-term success of the interventions, the following methodologies were applied:
- Patient Follow-up: Patients were contacted via telephone to assess their current working status and donor site complaints.
- Functional Assessment: The Quickdash questionnaire was administered to 53 reachable patients.
- Data Collection: Operative techniques, secondary procedures, finger survival rates, and physiotherapy data were analyzed retrospectively.
Clinical Results and Surgical Outcomes
The surgical interventions varied based on the specific needs of the hand injury. The distribution of the procedures and the resulting success rates are detailed below:
| Procedure Type | Number of Patients |
|---|---|
| Trimmed great toe to thumb transfer | 36 |
| Second toe-to-thumb transfer | 8 |
| Second toe-to-finger transfer | 10 |
| 2 toes transfer (unilateral) | 13 |
| 3 toes transfer (unilateral) | 6 |
| Bilateral toe transfers | 9 |
| Joint transfers (including bilateral) | 8 |
Key Performance Indicators:
- Finger Survival Rate: The overall survival rate for the transfer procedures was recorded at 95.04%.
- Quickdash Scores: The average score among reachable patients was 27.49.
- Employment Status: 88.7% of patients were able to return to work. Specifically, 62.3% returned to their previous jobs, while 26.4% required a job change due to their injuries.
- Donor Site Feedback: 41.5% reported no complaints, 47.2% reported mild complaints, and 11.3% reported major complaints regarding the donor site.
Technical Considerations in Toe-to-Hand Transfers
Achieving a functional hand requires delicate planning and the consideration of multiple-toe transfer techniques alongside flap coverage options. Advanced microsurgical insights from the study include:
- Single Operation Capacity: By dissecting both the dorsal and plantar arterial systems, it is possible to transfer three toes, including the great toe, in a single session.
- Crush Injury Reconstruction: Injuries on the dorsal side of the hand can be reconstructed using combined transfers of bones, joints, extensor tendons, and skin.
- Functional Recovery: The ultimate goal is to achieve at least a basic or acceptable hand function, allowing the patient to reintegrate into professional life.
Conclusion
In conclusion, free-tissue transfers from the foot are highly effective for treating mutilating hand injuries. With a finger survival rate of over 95% and a high return-to-work ratio, these microsurgical techniques remain a cornerstone of hand reconstruction. Proper planning and the use of combined tissue transfers are mandatory for optimal functional outcomes.
Keywords: Microsurgery, Mutilated hand, Reconstruction, Toe to hand, Toe to thumb, Free-tissue transfer.
