Subcutaneous abdominal pocket for soft-tissue preservation and reconstruction after traumatic digits amputation

Abstract

Aim: To represent a clinical case, which demonstrates the benefits of subcutaneous abdominal pocket as a surgical treatment method to achieve reconstruction after partial traumatic digits amputation. Method: 45 y.o. patient experienced partial traumatic amputation of II – V digits of his right hand. Patient accidentally inserted his hand into a meat grinder. All soft tissues were shredded, only middle and some distal phalanges, few tendons, nerves and vessels were preserved. Patient was admitted to Plastic and Reconstructive Surgery Department of Kaunas Clinics. Necrectomy was performed. Subcutaneous pocket in patient’s lateral abdominal wall was prepared for hand insertion. A hand was inserted into formed pocket to keep remaining tissues viable and to achieve soft tissue repair. Patient’s hand was kept in a pocket for a month. On a dorsal part of the hand abdominal skin and subcutaneous tissues were kept as a flap, on a palm - split-thickness skin grafting, using skin from right thigh was used. Osteosynthesis and finger forming reconstructive surgeries were performed. Skin defect in abdominal wall was covered using split-thickness skin graft. 10 days after the surgery necrosis of middle and distal phalanges occurred. III-V digits’ middle and distal phalanges were amputated. In total 4 surgeries were performed which led to restoration of patient’s hand and proximal phalanges. Results / Discussion: 4 months following the trauma – reconstructed hand and remaining fingers are well healed, patient has regained sensation, although complete hand function is impossible. Conclusion: Subcutaneous abdominal pocket can be a successful treatment method for traumatic wounds to preserve tissue viability and for further soft tissue reconstruction.