Upper Extremity Reconstruction

Injuries are the most frequent causes of need for upper extremity reconstruction.

 

Transplanting fingers by hand

In the case of amputations of fingers of the hand, either of one or several fingers, the transfer of one or several fingers of the foot to the hand may be indicated. The first time this surgery was performed in 1900 by Carl Nicoladoni in Austria. The procedure was carried out by keeping the patient’s hand attached to the foot for weeks, until the transferred finger was vascularized by the tissue of the hand, and then disconnected the hand of the foot. The obvious inconvenience of this way of performing surgery made it unpopular in those days. With the development of microsurgery it is currently possible to transfer a toe to replace the missing finger in a single surgery and obviously without keeping the patient in a very uncomfortable position for weeks.

The main indication from the point of view of the function of the hand is given in patients who have lost their thumb, which accounts for approximately 50% of the function of the hand. Second, there are the long fingers of the hand. This surgery is indicated for patients who feel great distress from the missing finger. On some occasions, the transfer of only the pulp, or of the latter and the nail with the help of microsurgery, may be indicated.

The loss of some toes, when the surgery is done correctly, does not cause problems in walking. Some are even difficult to perceive from the aesthetic point of view.

Each patient must put on a balance what he loses (one or several toes) versus what he can gain, a more aesthetic and above all, more functional hand.

 

Alejandro Ramírez