Opposable triphalangeal digital stump transplanted with microvascular anastomoses in patients with frostbitten hands and feet (case report)

The objective was to explore possibilities with reconstruction of opposable digital stump of the hand transplanted with microvascular anastomoses in frostbite patients. Material and methods Medical histories and long-term results of treatment of two frostbite patients with finger stumps of both hands were reviewed. The triphalangeal finger and the thumb were reconstructed by transplanting the opposable finger stump together with the metacarpophalangeal joint using microvascular and microneural anastomoses. The stumps were mobilized and transplanted to the distal ulnar artery with the venous drainage performed using the dorsal saphenous vein of the hand. Long-term results were examined at 10 years and 2.5 years of surgery. Clinical, radiological, biomechanical and biophysical investigations were produced. Results The bilateral gripping function was restored in recipient stumps without functional damage to the donor stumps. Discriminatory sensitivity of reconstructed fingers was 6mm and 8 mm, the range of active motion in the transplanted joint was 55 and 66 degrees. Discussion Opposable digital stump transplantation with microvascular anastomoses has significant advantages over the classical surgery. The technique allows for one-stage restoration of a finger to have sufficient length, function, adequate blood supply and innervation due to a short digital stump being transplanted with the metacarpophalangeal joint. The advantage over a toe transplant consists of the use of digital structures of the hand that are identical in functionality and the anatomy reducing the need for secondary interventions. Conclusion The method of management can be successfully applied for frostbite patients with hand stumps according to indications.