title: Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries.
abstract: BACKGROUND
  In cases of mutilating hand injuries, the primary goal is recovery of prehensile function. This is particularly true in the case of joints, which are extremely difficult to replace or reconstruct adequately when damaged. Heterotopic vascularized joint transfer is indicated when salvageable joints are available for transfer to a more functionally optimal position on the hand.
  
  
  METHODS
  Seven cases of mutilating hand injuries treated with heterotopic vascularized joint transfers from 2003 to 2012 were retrospectively identified. All patients sustained severe metacarpophalangeal joint (MPJ) or proximal interphalangeal joint (PIPJ) damage that threatened recovery of optimal hand function. All patients were men, with an average age of 34.7 years. Operative, perioperative, and postoperative details including final active range of motion were collected and analyzed.
  
  
  RESULTS
  Seven joints were taken from nonsalvageable amputated digits: 4 from the amputated parts, and 3 from the proximal stumps. Five joints were transferred as free flaps requiring microvascular anastomosis, and 2 were transferred on neurovascular pedicles. One joint was lost due to vasospasm. Average active range of motion was 68.3° for homojoint transfers (MPJ to MPJ, PIPJ to PIPJ), and 35° for heterojoint transfers. All but 1 patient were able to achieve tripod pinch; the remaining patient achieved only side-to-side pinch.
  
  
  CONCLUSIONS
  Heterotopic vascularized joint transfer is a useful technique to consider in cases of mutilating hand injuries. Improved recovery of prehensile function can be achieved with thoughtful design and execution, followed by proper patient education and rehabilitation.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center. Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan; and †Department of Plastic Surgery, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Chang
authors.forename: Johnny T
authors.initials: JT
authors.lastname: Chang
authors.forename: Chung-Chen
authors.initials: CC
authors.lastname: Hsu
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Yu-Te
authors.initials: YT
authors.lastname: Lin
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D005384:Finger Joint / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007596:Joints / Q000098:blood supply / Q000637:transplantation*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016042:Transplantation, Heterotopic / Q000379:methods*; D016896:Treatment Outcome