J Reconstr Microsurg 2004; 20(1): 3-6
DOI: 10.1055/s-2004-818042
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA

Primary Reconstruction of a Degloved Hand Using Multiple Toe Transfers on a Single Pedicle and a Reversed Radial Artery Flap

B. P. Thomas1  Orth. , T. M. Tsai2
  • 1Senior Fellow, Christine M Kleinert Institute of Hand and Microsurgery, Louisville, KY
  • 2Clinical Professor, Orthopedic Surgery, University of Louisville School of Medicine, Louisville, KY
Further Information

Publication History

accepted: July 28, 2003

Publication Date:
18 February 2004 (online)

This case study reports one-stage reconstructive surgery on an 18-year-old man who was injured by an industrial roller machine and who presented with a degloved hand. Non-replantable delgloving occurred in all fingers, with the loss of the palmar and part of the dorsal skin. Multiple free contiguous toes were transferred based on a single dorsalis pedis artery pedicle. The artery was anastomosed to a reversed radial artery flap, which was used to cover the palm for primary reconstruction of the degloved hand. Multiple toes were harvested from the same foot, based on a single pedicle, to contain the potential morbidity to one foot, to enable primary reconstruction, and to decrease the length of the operation. The flaps healed well, and the patient demonstrated adequate tripod pinch and key pinch with the transferred toes, with a two-point discrimination of 12 mm at 1-year follow-up. The patient was satisfied with both the appearance and function of the hand and foot.

REFERENCES

  • 1 Valauri F A, Buncke H J. Thumb and finger reconstruction by toe-to-hand transfer.  Hand Clin. 1992;  8 551-574
  • 2 Wei F C, el-Gammal T A. Toe-to-hand transfer. Current concepts, techniques, and research.  Clin Plast Surg. 1996;  23 103-116
  • 3 Lister G D, Kalisman M, Tsai T M. Reconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers.  Plast Reconstr Surg. 1983;  71 372-386
  • 4 Tsai T M, Jupiter J B, Wolff T W, Atasoy E. Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer.  J Hand Surg. 1981;  6 319-328
  • 5 Wei F C, Chen H C, Chuang C C, Noordoff M S. Simultaneous multiple toe transfers in hand reconstruction.  Plast Reconstr Surg. 1988;  81 366-377
  • 6 Yim K, Wei F C. A comparison of primary and secondary toe-to-hand transplantation. Presented at the 12th Annual Meeting of the American Society for Reconstructive Microsurgery, Boca Raton, FL, January 1997
  • 7 Culp R W, Lineaweaver W C, Partington M, Taras J. A complex free toe transfer after a reverse radial forearm flap.  J Hand Surg. 1995;  20 59-62
  • 8 Mahoney J, Naiberg J. Toe transfer to the vessels of the reversed forearm flap.  J Hand Surg. 1987;  12 62-65
  • 9 Godina M. Early microsurgical reconstruction of complex trauma of the extremities.  Plast Reconstr Surg. 1986;  78 285-292
  • 10 Lister G, Scheker L. Emergency free flaps to the upper extremity.  J Hand Surg. 1988;  13A 22-28
  • 11 Wei F C, Colony L H, Chen H C, et al.. Combined second and third toe transfer.  Plast Reconstr Surg. 1989;  84 651-661
  • 12 Ninkovic M, Deetjen H, Ohler K, Anderl H. Emergency free tissue transfer for severe upper extremity injuries.  J Hand Surg. 1995;  20B 53-58
  • 13 Tsai T M. Second and third toe transplantation to a transmetacarpal amputated hand.  Ann Acad Med Singapore. 1979;  8 413-418
  • 14 Rose E H, Buncke H J. Simultaneous transfer of right and left second toes for reconstruction of amputated index and middle fingers in the same hand-case report.  J Hand Surg. 1980;  5 590-593
  • 15 Wei F C, Colony L H. Microsurgical reconstruction of opposable digits in mutilating hand injuries.  Clin Plast Surg. 1989;  16 491-504

T. M. TsaiM.D. 

Christine M. Kleinert Institute of Hand and Microsurgery

225 Abraham Flexner Way, Suite 850

Louisville, KY 40202