Transposed replantation of fingers at forearm bones in severe segmental injuries across the hand and wrist.

There are situations in which amputated hands or fingers cannot be replanted directly back to their original positions. When there is severe segmental injury across the hand and wrist but one or several fingers are still healthy, the fingers can be selected to be replanted at the forearm bones to restore pinch function. This is different from the toe to antebrachial stump transplantation presented by Dr. Vilkki. From the results in four patients, the following conclusions are drawn: (1) When the fingers are replanted at the forearm bone(s), only pinch function can be obtained. There is no opposition. (2) Grip function is weak because the intrinsics are lost and only a few fingers are replanted. The forearm bones are often shortened, as are the flexors. (3) Of particular importance is the creation of a large web space between the radial digit and ulnar digit(s), because fingers are longer than toes. (4) The sensory recovery is not so good as in ordinary finger replantation. However, this is a salvage procedure. Regardless of these facts, the patients are still satisfied with the results out of such severe injuries. With good pinch function, not only are they independent in daily life, but they also can do a lot of work. It is a worthwhile procedure. A functional prosthesis can be added distally after this replantation.