J Reconstr Microsurg 2004; 20(3): 201-205
DOI: 10.1055/s-2004-823107
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Restoration of Basic Hand Function by Double Transpositional Digital Replantation in Five-Digit Amputations

Tai-Ju Cheng1 , Nai-Chen Cheng2 , Yueh-Bih Tang2
  • 1Division of Plastic Surgery, Department of Surgery, En Chu Kong Hospital, Taipei, Taiwan
  • 2Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
Further Information

Publication History

Accepted: 3 December 2003

Publication Date:
16 April 2004 (online)

In multiple digital amputations with severe crush injury, replantation of digits with a poor prognosis is often fruitless. Those digits with a favorable prognosis should be selectively replanted in positions that provide optimal functional outcome, regardless of their anatomic origins: this is the principle of transpositional replantation. The authors present a case of right-hand crush injury with amputation of all five digits. Basic hand function was restored by double transpositional digital replantations without additional reconstructive procedures. In properly selected cases, such procedures can preserve greater hand function and reduce the necessity for secondary operations. It is suggested that transpositional replantation should be considered when multiple digital amputations are encountered.

REFERENCES

  • 1 Wolff T W, Kleinert H E. Digital replantation.  Ann Plast Surg. 1979;  3 433-442
  • 2 Kleinert H E, Juhala C A, Tsai T M, Van Beek A. Digital replantation-selection, technique, and results.  Orthop Clin No Amer. 1977;  8 309-318
  • 3 Morrison W A, O'Brien B M, MacLeod A M. Digital replantation and revascularisation. A long term review of one hundred cases.  Hand. 1978;  10 125-134
  • 4 Morrison W A, O'Brien B M, MacLeod A M. A long-term review of digital replantation.  Austral NZ J Surg. 1977;  47 767-773
  • 5 Buck-Gramcko D. Thumb reconstruction by digital transposition.  Orthop Clin No Amer. 1977;  8 329-342
  • 6 Harkins P D, Rafety J E. Digital transposition in the injured hand.  J Bone Joint Surg. 1972;  54A 1064-1069
  • 7 Chow J SA, Bilos Z J, Chunprapaph B. Thirty thumb replantations: indications and results.  Plast Reconstr Surg. 1979;  64 626-630
  • 8 Earle M J, Watson J S. Twenty four thumb replantations.  J Hand Surg. 1984;  9B 98-102
  • 9 Schwabegger A H, Harpf C, Rumer A et al.. Transpositional replantation of digits. Case reports.  Scand J Plast Reconstr Surg Hand Surg. 1999;  33 243-249
  • 10 Chiu H Y, Lu S Y, Lin T W, Chen M T. Transpositional digital replantation.  J Trauma. 1985;  25 440-443
  • 11 Soucacos P N. Indications and selection for digital amputation and replantation.  J Hand Surg. 2001;  26B 572-581
  • 12 Soucacos P N, Beris A E, Malizos K N et al.. Transpositional microsurgery in multiple digital amputations.  Microsurgery. 1994;  15 469-473
  • 13 Rose E H, Buncke H J. Selective finger transposition and primary metacarpal ray resection in multidigit amputations of the hand.  J Hand Surg. 1983;  8A 178-182
  • 14 Tamai S. Twenty years' experience of limb replantation-review of 293 upper extremity replants.  J Hand Surg. 1982;  7A 549-556
  • 15 Chen H C, Lin C H, Wei F C et al.. Transposed replantation of fingers at forearm bones in severe segmental injuries across the hand and wrist.  Plast Reconstr Surg. 1994;  94 951-957

Nai-Chen ChengM.D. 

Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital

7 Chung-Shan South Road

Taipei 100, Taiwan

    >