Nguyen Viet Tan, Le Van Doan
Upper extremity trauma and Microsurgery Department, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hanoi, Viet Nam.
Upper extremity trauma and Microsurgery Department, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hanoi, Viet Nam.
Int J Surg Case Rep. 2025 Jan;126:110774. doi: 10.1016/j.ijscr.2024.110774. Epub 2024 Dec 26.
Reconstruction for open multiple transmetacarpal amputation secondary to a crushing injury is really challenging. Some treatment approaches could be proposed. To avoid the drawbacks of a prosthesis and hand transplantation such as the high cost, and long-term side effects of anti-rejection drugs, toe transfers were chosen.
A 33 year-old man suffered a crushing injury that led to a left transmetacarpal amputation and a right arm amputation. The left hand was reconstructed by toe transfers to restore the thumb, index and middle fingers. After 75 months of follow-up, on the left hand, the patient could recover tripod pinch. Tripod pinch strength was 4 pounds, grip strength was 10 pounds. Static 2 points discrimination of the reconstructed thumb, index, and middle fingers was 12, 13, and 15 mm, respectively. The maximum grip span was 8 cm. With the left reconstructed hand, the patient could return to almost all activities in daily life and work.
For this case, toe transfers seems to be more suitable and effective than other methods. Tripod pinch reconstruction provides stability, a strong grip, a wide working-distance, and a good appearance.
This case highlights the efficacy of tripod pinch reconstruction by toe transfers in addressing complex transmetacarpal amputation, providing effective solution even when the contralateral upper extremity was also amputated.
因挤压伤导致的开放性多发掌骨截肢的重建手术极具挑战性。可提出一些治疗方法。为避免假体和手部移植的缺点，如成本高昂以及抗排斥药物的长期副作用，选择了足趾移植。
一名33岁男性遭受挤压伤，导致左手掌骨截肢和右上肢截肢。通过足趾移植重建左手，以恢复拇指、示指和中指。经过75个月的随访，左手患者可恢复三指捏。三指捏力为4磅，握力为10磅。重建拇指、示指和中指的静态两点辨别觉分别为12、13和15毫米。最大握距为8厘米。利用重建的左手，患者几乎可以恢复日常生活和工作中的所有活动。
对于该病例，足趾移植似乎比其他方法更合适且有效。三指捏重建提供了稳定性、有力的握力、较宽的工作距离和良好的外观。
本病例突出了通过足趾移植进行三指捏重建在处理复杂掌骨截肢方面的疗效，即使对侧上肢也被截肢时也能提供有效的解决方案。
