This 17-year-old right-handed boy sustained a bomb blast injury to his left hand resulting in a subtotal thumb amputation and partial amputations of the middle, ring and little fingers. The index finger suffered a proximal interphalangeal fracture and had some residual stiffness but was essentially intact.
A dorsal triangular flap was included with the middle finger stump. The extensor digitorum communis tendon was transected. Several dorsal veins and branches of the superficial radial nerve were included in the flap for later venous augmentation and neural coaptation. The middle finger stump was isolated based on the ulnar neurovascular bundle. A step-cut osteotomy was designed to allow 110 to 130 degrees of pronation. The middle finger stump was mobilized to the thumb position on its ulnar neurovascular bundle and intact flexor digitorum sublimis tendon. Fixation of the step-cut osteotomy was accomplished using a single screw. Following this, extensor tenorrhaphy to the extensor pollicis longus tendon, coaptation of the superficial radial nerve branches and venous anastomoses were performed.
Here is the patient at one-year follow-up.