title: Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps.
abstract: OBJECTIVE
  Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed.
  
  
  METHODS
  From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days.
  
  
  RESULTS
  All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery.
  
  
  CONCLUSIONS
  Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option.
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China.
authors.forename: Xiucun
authors.initials: X
authors.lastname: Li
authors.forename: Jianli
authors.initials: J
authors.lastname: Cui
authors.forename: Suraj
authors.initials: S
authors.lastname: Maharjan
authors.forename: Xin
authors.initials: X
authors.lastname: Yu
authors.forename: Laijin
authors.initials: L
authors.lastname: Lu
authors.forename: Xu
authors.initials: X
authors.lastname: Gong
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D019737:Transplants; D055815:Young Adult