PMC5707116_01
Midcarpal amputation of the hand, complete avulsion of the long fingers till midcarpal with extensive soft tissue defect.
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He sustained a midcarpal amputation of the hand, a complete avulsion of the long fingers, a splitting of the forearm with extended palmar soft tissue flap, dorsal extensive soft tissue defect with laceration of the extensor muscles and an open ulnar shaft fracture, defined as third grade (IIIB) according to the classification of Gustilo and Anderson (Figure 1).
The thumb was fixed to the radius in sense of a Vilkki-Procedure.
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In the first operation after debridement and osteosynthesis of the ulna, the thumb was pinned to a small decorticated area five centimetres (cm) proximal to the radial styloid in sense of a Vilkki-Procedure (Figure 2).
The anterolateral thigh flap.
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In order to cover the large soft tissue defect, while in addition simultaneously reconnecting a palmar artery of the thumb to the radial artery and a dorsal vein to one in the forearm, an anterolateral thigh (ALT) flap was used as an emergency free flow-through flap (Figure 3).
The resensibilisation with a sural nerve graft.
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Therefore, a sural nerve graft was used to restore sensitivity (Figure 4).
The motorisation of extensor function with a plantaris longus tendon graft.
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Simultaneously, to accomplish the extensor function, the extensor carpi radialis longus was connected with extensor pollicis longus by a plantaris longus tendon graft (Figure 5).
Result 1 year after surgery good soft tissue conditions.
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One year after the operation, he was able to return to work in a bigger factory and a more modern workplace with highly automated machinery (Figures 6 and 7).
Result 1 year after surgery with excellent gripping ability.
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One year after the operation, he was able to return to work in a bigger factory and a more modern workplace with highly automated machinery (Figures 6 and 7).