Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

Purpose

Complex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem.

Methods

This study retrospectively reviewed four cases that underwent single or multiple fingers’ reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented.

Results

All the patients were men, aged between 21 and 45 years (median age: 31.75). One of them injured the left-dominant hand, and the other three their right-dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range: 3–36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (second and fourth), and one patient had three fingers amputated (second, third, and fourth). In the first patient, a true flow-through flap and a second toe transfer were done, and in the other three patients, multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients.

Conclusions

Toe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods is very useful, especially in cases with few vascular resources.

Type of study/level of evidence

Therapeutic IV.