PMC8274534_01
Oblique view of the blast injury resulting in dysvascular right thumb and flexor tendon injury to the index finger.
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His right hand injuries included predominantly full-thickness burns to the thumb, index, and long fingers, a dysvascular thumb beyond the interphalangeal joint (IP) and blast injuries causing segmental loss of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the index finger (Figures 1 and 2).
Lateral view of the blast injury.
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His right hand injuries included predominantly full-thickness burns to the thumb, index, and long fingers, a dysvascular thumb beyond the interphalangeal joint (IP) and blast injuries causing segmental loss of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the index finger (Figures 1 and 2).
Wound appearance following split thickness skin grafting in the sub-acute period.
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Further soft tissue coverage of the right hand was achieved with split thickness skin grafting several weeks later (Figure 3).
PA view of the hand 18 months following the original injury.
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After intensive occupational therapy and tissue softening, at approximately 1.5 years after the initial injury, the patient was considered a good candidate for definitive reconstruction of the right hand, which was comparatively unusable (Figures 4 and 5).
Lateral view of the hand 18 months following the original injury.
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After intensive occupational therapy and tissue softening, at approximately 1.5 years after the initial injury, the patient was considered a good candidate for definitive reconstruction of the right hand, which was comparatively unusable (Figures 4 and 5).
Preoperative markings for "on-top"-plasty of the long finger to the thumb position - PA view.
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Due to a complex social situation and poor function of the long finger flexors and extensors, the decision was made to transpose the long finger as a fixed/stable 'post' to the thumb position (Figures 6 and 7).
Preoperative markings for "on-top"-plasty of the long finger to the thumb position - PA bird's-eye view.
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Due to a complex social situation and poor function of the long finger flexors and extensors, the decision was made to transpose the long finger as a fixed/stable 'post' to the thumb position (Figures 6 and 7).
Dissection of the long finger on the ulnar digital neurovascular bundle.
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The right long finger was transposed to the thumb position on the ulnar neurovascular pedicle, which was dissected to its origin at the palmar arch, and which was the only intact pedicle to the finger (Figure 8).
Partial ray resection of the long finger metacarpal and transposition of the remaining digit on the ulnar neurovascular pedicle.
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Using a sagittal saw the right long finger was transected through the proximal phalanx close to the MP joint and part of the remaining metacarpal removed as a ray resection to deepen the webspace and improve prehension (Figure 9).
Post-operative appearance following Kirschner wire fixation of the long finger onto the thumb metacarpal.
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Two 0.062 K-wires were placed retrograde into the thumb metacarpal and then driven obliquely into the new thumb proximal phalanx (Figure 10).
3 month post-operative appearance - oblique view of the hand.
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At 3 months post-operatively he has adequate bony fusion and a 5-pound tip pinch strength (Figures 11-14).
3 month post-operative appearance - lateral view of the hand.
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At 3 months post-operatively he has adequate bony fusion and a 5-pound tip pinch strength (Figures 11-14).
3 month post-operative appearance - PA view of the reconstructed thumb.
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At 3 months post-operatively he has adequate bony fusion and a 5-pound tip pinch strength (Figures 11-14).
Nascent fusion between the thumb metacarpal and the middle finger proximal phalanx 3 months post-operative.
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At 3 months post-operatively he has adequate bony fusion and a 5-pound tip pinch strength (Figures 11-14).