PMC6220740_01
The Left hand after amputation. The middle and ring fingers were amputated proximal to the proximal interphangeal joint and, the small finger was amputated distal to the proximal interphalangeal joint.
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The injured fingers were not replantable; therefore, amputation of the middle and ring fingers at the level of the proximal phalanx and of the little finger at the middle phalanx was performed at another hospital (Figure 1).
Preoperative X-ray confirms findings based on hand appearance. Nonunion of the proximal phalanx is seen.
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Radiographic images confirmed the clinical findings (Figure 2).
Enhanced computed tomography was used to evaluate toe vasculature before surgery.
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Examination of foot vascularity with contrast-enhanced computed tomography confirmed that bilateral STT was compatible for the reconstruction of two fingers (Figure 3).
Design of the hand. We confirmed the dorsal metacarpal vein with ultrasonography.
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A curved incision was made over the volar surface of the distal middle and ring fingers (Figure 4).
Closure of right donor site with a knotless suture fixation system (ZipTight ). The device tightened the space between the metatarsal bones of the first and third toes.
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The foot was closed with a knotless suture fixation system (ZipTight ; Arthrex Inc., FL, USA) to firmly close the wound, avoiding unwanted reduction of tension during the closure (Figure 5).
X-ray of the hand after transplantation. The second toe and proximal phalanx are fixed with a plate.
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The veins and arteries at the donor site were anastomosed to the dorsal veins and digital arteries with 10-0 suture (Figure 6).