Synopsis ■ Microsurgical toe-to-hand transplantation allows “like-with-like” reconstruction, achieving the best functional and aesthetic results. ■ Preservation of neurovascular bundles, flexor and extensor tendons, mobile joints, and viable skin with minimal bone shortening in the amputation stump ensures optimal functional…
Synopsis ■ Thumb reconstruction should aim to restore the cardinal thumb actions: mobility, stability, sensibility, length, and appearance. ■ Level of thumb loss is divided into thirds: distal (tip to interphalangeal joint), middle (interphalangeal joint to metacarpal neck), and proximal…
Synopsis ■ A mutilating hand injury is a severe injury with tissue loss that results in loss of prehension. ■ The goal of management is to obtain a stable wrist, with at least two opposable sensate digits and a wide…
Synopsis ■ Replantation has evolved through the development of advanced optics and microsurgical techniques. Every patient should be carefully evaluated and considered a candidate for replantation unless the patient declines or is unable to tolerate surgery. ■ The steps for…
Synopsis ■ A thorough understanding of the complex anatomy is crucial for successful treatment of extensor tendon injuries. ■ Injuries are classified into nine anatomic zones. Treatment strategies vary considerably according to the location of the lesion, ranging from splinting…
Synopsis ■ Tendons transmit forces generated by muscles to move joints or to create action power. Flexor tendon injuries are common, but recovery of satisfactory function, particularly after injuries within the digital sheath, is sometimes difficult. Lacerated flexor tendons should…
Synopsis ■ Wrist injuries are common, and proper management relies on an understanding of normal anatomy, alignment, and kinematics. ■ Scaphoid fractures can be subtle, and due to the precarious blood supply to this bone, may go on to non-union…
Synopsis ■ Diagnosis of hand fractures and joint injuries requires history, examination, and adequate imaging studies. ■ Treatment decisions are based on fracture geometry, stability, and individual patient needs. ■ Nonoperative principles include reduction, maintenance of reduction through casting, splinting…
Synopsis ■ Fingertip and nail bed injuries are the most common injuries of the hand. ■ Large subungual hematomas should be drained to relieve pressure and pain; small and asymptomatic hematomas (<50%) can be observed. Trephination of a subungual hematoma…
Synopsis Careful preoperative planning facilitates safe and expeditious surgery. ■ Ligamentotaxis relies on the intact soft-tissue envelope. By applying linear traction, it indirectly reduces fragments via the intact periosteum, ligaments, and soft tissues. ■ The most appropriate method of fracture…