title: Heterotopic Procedures in Mutilating Hand Injuries: A Synopsis of Essential Reconstructive Tools.
abstract: BACKGROUND
  In the complex and challenging treatment of a mutilating hand injury, any available resources need to be primarily recruited. Besides direct digital replantation, the tissue of the nonreplantable "spare parts" could often be "recycled," and also some replantable or injured structures could be "redistributed" in a more functional individualized pattern, irrespective of their initial origin.
  
  
  METHODS
  Ten patients, six male and four female, were treated for multidigital mutilating injury with various "heterotopic" procedures. Immediate digital heterotopic replantations were performed in seven patients. In one case, the bone and skin of a nonreplantable digital part were used as grafts in the reconstruction of a metacarpal bone and the overlying skin defect. A neurovascular fillet flap from a nonreplantable finger for the reconstruction of the webspace and a pollicization of an injured index were undertaken in two further cases. Another patient underwent pedicled transfer of the proximal interphalangeal joint and metacarpal bone of an impaired index to the middle finger.
  
  
  RESULTS
  Sensate prehensile function was restored in 100 percent of the cases, and the ability for tripod pinch and more subtle tasks was restored in 90 percent. The minimum of two long fingers and a thumb was restored in every case, and the patients judged the appearance of their hands as "acceptable."
  
  
  CONCLUSIONS
  In the reconstruction of a mutilating hand injury, besides and beyond the straightforward microsurgery, the various heterotopic procedures are essential reconstructive tools that can enhance the versatility of the hand surgeon when pursuing a better outcome.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Kaohsiung, Taiwan; and Thessaloniki, Greece From the Department of Plastic and Reconstructive Surgery, E-Da hospital, I-Shou University; and the Department of Plastic and Reconstructive Surgery, Aristoteles University of Thessaloniki, Papageorgiou General Hospital, Periferiaki Odos N. Efkarpia.
authors.forename: Effrosyni
authors.initials: E
authors.lastname: Kokkoli
authors.forename: Georgia-Alexandra
authors.initials: GA
authors.lastname: Spyropoulou
authors.forename: Hsiang-Shun
authors.initials: HS
authors.lastname: Shih
authors.forename: Guan-Ming
authors.initials: GM
authors.lastname: Feng
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006115:Greece; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome