Research Article
Volume 12 Issue 8 - 2021
Transposition of Hand Segments in Children with Traumatic Loss of First Radius
NM Aleksandrov, SV Petrov and ID Veshaev*
Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
*Corresponding Author: ID Veshaev, Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia.
Received: May 13, 2021; Published: July 29, 2021




Abstract

Introduction: This study investigates the possibilities of reconstructing amputated fingers in children by various methods of hand segment transposition.

Materials and Methodology: We have carried out a retrospective study analyzing the outcomes of reconstructive surgery of thumbs and fingers performed on injured hands by way of segment transposition in 28 children. The defect origins included mechanical injuries (10), gunshot wounds (11), burns (6), and a frostbite (1). In total, 29 fingers were reconstructed by transferring intact (3) and mutilated (2) fingers, finger stumps (13), and metacarpal stumps (11). The surgeries were performed using traditional (14) and non-traditional (15) techniques. In 25 cases, segment transposition required skin grafting with donor material harvested from remote sites. We have developed new approaches that allow to transfer a mutilated finger or any stump of a proximal phalanx or a metacarpal bone regardless of their location, amputation level, nature of hand defect, degree of soft tissue scarring and blood flow impairment, and allow also to ensure adequate prevention of ischemic complications.

Results: All the transposed segments healed, including segments with total tissue scarring and vessel damage. According to the long-term outcome analysis, hand grip was restored in 23 cases. Transposition of intact fingers resulted in the best outcomes. The use of non-salvageable segments (otherwise discarded) allowed to restore bilateral grip with minimal donor defect. Two-point discrimination results were 2 mm after finger transfers, 4.5 mm after finger stump transfers, and 6.5 - 7.4 mm after metacarpal stump transfers.

Conclusion: Transposition of the segments of an injured hand in children to reconstruct the thumb yields acceptable functional and anatomical results. This method can be used in finger reconstruction on a par with other techniques. Our new approaches to technique and treatment tactics make it possible to broaden the criteria of segment viability and the indications for this procedure.

 

Keywords: Hand Finger Stumps; Children; Pollicization; Transposition of Finger and Metacarpal Stumps; Indications for surgery; Treatment Outcomes

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Citation: ID Veshaev., et al. “Transposition of Hand Segments in Children with Traumatic Loss of First Radius”. EC Orthopaedics 12.8 (2021): 57-66.

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