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Heterotopic Replantation of the Fingers as a Variant of Reconstructive Surgery of the Hand
Mismil Muradov, MD, PhD; Timur Sadykov, MD, Resident; Pawel Saik, MD; Yermek Akhmetov, MD, PhD
Reconstructive and Plastic Microsurgery, NSCS, Almaty, Kazakhstan

Hypothesis: Predominantly, in the case of irreparable injury of fingers the surgeons perform heterotopic replantation (HR) of the most preserved amputated fingers into the most advantageous functional positions or into the most preserved stumps of the fingers. Here, we would like to present the results of our comparative analysis of heterotopic and orthotopic replantations (OR) of fingers after multiple traumatic amputations (MTA).
Methods: From January 2009 to January 2013 we treated 21 patients with MTA of fingers. Total number of amputated fingers was 67. 31 (46%) of them were replanted, among them 22 (71%) were HR and 9 (29%) OR. Most patients (64.7%) had "poor" mechanism of injury - crushing or avulsion. In determining the indications for HR we took into account that the priority of replantation in MTA of fingers increases from V to I, restoration of which is necessary first of all. We did not performed the recovery of finger II in case of a salvage of functionally important feature of "wide grip" of the hand, as the finger II replantation with inadequate functional outcome may affect the functionality of the hand as a whole, therefore, the functions entrusted to the finger III.
Results: In the long term period (6 months to 4 years) good results were obtained in 16 patients after HR of 14 fingers and OR of 3 fingers. All patients had recovery of cylindrical, spherical, pincer and fist grip, complete true opponency of I finger. The ability to bend replanted finger I up to 3 cm and recovery of sensitivity to normesthesia were also restored. Satisfactory results were obtained in three patients after HR of two fingers and OR of two fingers. The patients had restrictions of all kinds of grips; replanted finger flexion to 1 cm; recovery of sensitivity to hypoesthesia. Finger I sensitivity was not restored. In the immediate postoperative period acute circulatory disorder-related necrosis occurred in 5 fingers, (4 - OR and 1 HR). Finally restored fingers vitality was achieved in 26 (83.8%) of all fingers.
Summary Points: Despite the technical difficulties encountered in HR of fingers with MTA caused by size discrepancy between the stump and heteroreplant and their elements, there is no significant difference in restoring the function of the operated fingers in these kinds of replantation. Growth of hand function in cases of HR of finger I indicates the effectiveness of this technique in MTA of fingers.


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