Application of Ilizarov device for transfer of deformed digits, digital stumps, and metacarpal stumps.

Abstract

Digital transfer on a pedicle comprising only the neurovascular bundle may lead to irreversible ischemia in cases of severe hand tissue scarring. Previously described methods of such a transfer are conditional on the donor stump's being longer than both the recipient stump and the reconstructed digit. The aim was to develop a method of transferring deformed digits and their stumps after prior distraction of both neurovascular bundles and cutaneosubcutaneous pedicles with the help of the Ilizarov device. We performed 2-staged transfer of mutilated digits, digital stumps, or metacarpals using the Ilizarov device for stretching pedicles at the first stage and subsequent segment transfer. The method was applied in 65 patients, with 77 digits reconstructed in 67 hands. Segments were transferred on palmar or both palmar and dorsal pedicles containing lipocutaneous bridges and neurovascular bundles. In 67 of 77 cases, amputation levels of transferred stumps were roughly comparable to those of stumps reconstructed. X-ray length of reconstructed digits averaged 84.44 +/- 3.55 mm. Successful acceptance of transferred segments and complete or partial recovery of the hand grip was achieved in all cases. Use of the Ilizarov device enables the digital reconstruction of short digits, allows transferring various hand segments, including pathologically changed ones, and ensures success even in cases where the donor digit is too short to consider single-stage pedicle transfer.