Contralateral Heterotopic Thumb-to-Thumb Replantation With Free Ulnar Forearm Fasciocutaneous Flap and Targeted Muscle Reinnervation.

Mangling hand injuries can be difficult to manage owing to the severity and heterogeneity of the injuries. Outcomes after reconstruction of unique injuries are less well-known but provide valuable insight. We present an unusual spare parts reconstruction of a bilateral upper-extremity mangling injury treated with a heterotopic thumb-to-thumb replantation, an acute forearm fasciocutaneous free flap, and targeted muscle reinnervation. This report highlights the utility of microsurgical reconstruction with available autogenous tissue in the acute setting.

Side-to-Side Versus Pulvertaft Extensor Tenorrhaphy-A Biomechanical Study.

PURPOSE: We hypothesized that a side-to-side (STS) tendon repair has biomechanical characteristics that match those of a Pulvertaft (PT) weave. METHODS: Thirty extensor tendons were harvested (4 extensor digitorum communis and 1 extensor indicis proprius from 6 cadaver arms). Three hand surgery fellows with similar backgrounds of training under the same conditions and precise standardized technique performed the repairs (5 PT and 5 STS per surgeon). After the repairs, the tendons were passed through a graft-sizing guide to determine bulk and results were expressed as a repaired versus native diameter ratio. The specimens were then tested for ultimate strength and fatigue properties. Failure type and mechanical properties were recorded and compared with those of the native tendon. RESULTS: The average peak force to failure was 93 ± 20 N for the STS and 62 ± 32 N for PT group. Relative strength ratio (repair strength compared with native tendon strength) was 37% ± 21% for the STS and 22% ± 11% for the PT group. In the STS group, all failures occurred as a result of tissue failure; however, in the PT, suture failures occurred in 3 tendons before tissue failure. The mean bulk ratio of the repaired site versus native proximal tendon was 37 ± 14% and 40% ± 22% more for the STS and PT groups, respectively. These values for native distal tendon were 28% ± 9.9% and 26% ±24 %, respectively for STS and PT repair. Furthermore, the bulk of the repaired site for the STS and PT groups was 4.2 ± 0.50 and 4.7 ± 1.2 mm, respectively. CONCLUSIONS: Side-to-side repair technique showed superior biomechanical properties while demonstrating comparable repair bulk of the tendon coaptation compared with the Pulvertaft weave. CLINICAL RELEVANCE: The results of this study may help guide a surgeon's choice of repair technique when addressing tendon injuries or tendon transfers.