J Korean Med Assoc.  2016 Feb;59(2):127-135. 10.5124/jkma.2016.59.2.127.

Reconstruction of hand

• Lee K
• Lee D
• Roh S
• Kim J

• KMID: 2153718
• DOI: http://doi.org/10.5124/jkma.2016.59.2.127

Abstract

The characteristics of hand trauma are changing due to automation of industrial facilities, improved access to health care, and the aging population. Since the inception of hand surgery as a subspecialty, hand defects have been reconstructed with the restoration of the original functionality as the primary goal. With advancement and maturation of surgical techniques, however, restoration of aesthetics also began to take hold as an important aspect of hand surgery practice. After the first successful replantation of an amputated digit, the rapid development of microsurgical techniques had a significant impact on the field of reconstructive hand surgery. In the first two decades, the success of replantation was evaluated by the survival rate for a single operator or a specialized institution. These days, however, microsurgical techniques have been widely adopted, with digital replantation possible even for infants. In addition to various local flaps, the evolution of free flaps has vastly expanded the repertoire of reconstructive options for hand surgeons. With the wide variety of free flaps available, it is possible for a severely injured hand to be salvaged and restored to its original functional and aesthetic status. In South Korea, hand surgery is becoming an established profession with a separate subspecialty certification. Hand surgery has a bright outlook, with future research directed at new biocompatible materials and novel reconstructive methods.

Keyword

Hand surgery; Replantation; Microsurgery

MeSH Terms

Aging
Automation
Biocompatible Materials
Certification
Esthetics
Free Tissue Flaps
Hand*
Health Services Accessibility
Humans
Infant
Korea
Microsurgery
Replantation
Survival Rate
Biocompatible Materials

Figure

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  Figure 1 Replantation. (A) Complete amputation of index finger at proximal phalanx base level. (B) Fracture fixation. (C) Tendon repair. (D) Digital artery and nerve anastomosis. (E) Dorsal vein anastomosis. (F) Immediate postoperative view.

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  Figure 2 Replantation in children (A) Multiple amputation of index and long finger. (B,C) One-year follow-up view after replantation, noted near normal appearance and growth.

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  Figure 3 Pollicization. (A) Left thumb defect due to avulsive injury. (B) Immediate postoperative view. (C) Six-months follow-up view.

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  Figure 4 Second toe transfer. (A) Multiple digital defect of right hand due to mutilating injury. (B) Donor site view. The second toe was selected. (C) Postoperative view.

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  Figure 5 Vascularized nail transfer. (A) Noted nail absence of thumb. (B) Vascularized big toe nail unit harvested. (C) Immediate postoperative view. (D) One-year follow-up view, showed near normal appearance.

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  Figure 6 Lateral arm free flap. (A) Skin and soft tissue defect of hand dorsum. (B) Immediate postoperative view. (C,D) One-year follow-up view.

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  Figure 7 Lateral arm fascia free flap. (A) Multiple skin defect of long and ring finger. (B) Vascularized fascia flap coverage with bridge pattern. (C) Six-months follow-up view after split thickness skin graft, noted acceptable finger contour.

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  Figure 8 Toe joint transfer. (A) Vascularized proximal interphalangeal joint harvested from second toe. (B) Preoperative X-ray finding, noted deformity of proximal interphalangeal joint of middle finger. (C,D) showed ulnar deviation and limitation of range of motion. (E) Intraoperative view. (F-H) Postoperative view, showed joint stability and increased range of motion.

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