Heterotopic replantation in mutilating hand injury.

To achieve optimal hand function in the reconstruction of a mutilated hand is quite a challenge, and every salvage procedure should be tried, especially for amputated parts that cannot be replanted to their original anatomic sites. Five patients who sustained work-related mutilating hand injuries and who underwent digital heterotopic replantation are reported. Two patients had irreparably crushed, amputated thumbs. One patient (patient 1) received heterotopic replantation of the ring finger to the thumb's position; the other patient (patient 2) received heterotopic replantation of the middle finger to the thumb. Three additional patients received digital heterotopic replantation to enhance hand function. Patient 3 underwent heterotopic replantation of the middle finger to the index finger's position. Patient 4 underwent transplantation of the middle finger to the index finger's position, the ring finger to the middle finger's position, and the little finger to the ring finger's position. In patient 5, the ring finger was transplanted to the index finger's position. In all patients, satisfactory results were achieved in hand function and wound healing. In these patients, the restoration of a functional thumb was the first priority, followed by establishing at least two opposable fingers at the sites where metacarpophalangeal joints were functional.