Abdominal pocketing for the child’s fingers for hand replantation: A clinical case

Abstract

BACKGROUND: The traumatic avulsion of fingers is a severe injury that requires emergency replantation. In the case of crush mechanism and degloving, direct vessel repair, and reconstruction may be impossible. It appears fair to use indirect revascularization by enveloping the phalanges after osteosynthesis with blood-supplied tissues. The most accessible anatomically and functionally are the lower abdominal flap and abdominal pocketing of the hand; the flap pedicle was cut and the hand was released. Staged surgeries could be required for functional and aesthetic reconstruction of acceptable soft tissue envelop of the hand. CLINICAL CASE: This is a clinical case of successful treatment of traumatic avulsion of II, III, IV fingers on the right hand by phalanx osteosynthesis and abdominal pocketing. The restoration of the functionally and aesthetically acceptable finger was achieved. DISCUSSION: There is a high risk of necrosis and stump formation after the replantation of severely injured fingers when there was any possibility for direct vessel repair. Another method is the indirect revascularization by blood vessel ingrowth from the flap through the fracture line. This saves the injured limb segment. CONCLUSIONS: The presented technique of abdominal pocketing allows the replantation of the avulsed and degloved fingers without microsurgical vascular operation and restores them. It appears fair to recommend this technique as a salvage surgery in the case of severely injured soft tissues of the avulsed hand fingers.