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Page 6 of 13 Murthy et al. Plast Aesthet Res 2020;7:64 I http://dx.doi.org/10.20517/2347-9264.2020.72

Figure 2. Following debridement, extensive destruction of the soft tissue envelope, extensor tendons (extensor digitorum communis,
extensor indicis, and extensor digiti minimi), and metacarpophalangeal joints is noted

CASE EXAMPLES
Case 1
A 19-year-old male was transferred to our trauma center after a motor vehicle accident. He was an
unrestrained driver and was ejected from the car, sustaining multiple injuries including a dorsal shearing
injury of the left hand. Focused examination of the extremity revealed that the fingers were well-perfused
and sensate. He was able to flex but unable to extend the fingers except the thumb.

He was taken to the operating room for exploration and debridement [Figure 2]. He was found to have
significant skin and soft tissue loss; segmental loss of the extensor tendons to all fingers and laceration
of the wrist extensors; open arthrotomies of the midcarpal and carpometacarpal joints; open fracture
dislocations of the metacarpophalangeal (MP) joints of the index through small fingers; open arthrotomy
long finger proximal interphalangeal joint; and dorsal radial sensory nerve loss.

At the index procedure, he underwent thorough excisional debridement and vacuum-assisted closure. He
returned to the operating room every 2-3 days for seven subsequent debridements. After this time, the
wound bed was deemed appropriate for definitive soft tissue coverage. He underwent free anterolateral
thigh flap from the right thigh to the left hand and wrist, along with placement of antibiotic cement spacers
in the MP joints of the index through small fingers [Figure 3]. Fasciocutaneous flap was used in this case to
allow ease of lifting the flap for the planned, secondary procedures.

Four months later, he underwent silastic MP arthroplasty of the index through small fingers and first stage
extensor tendon reconstruction of index through long fingers with placement of silastic tendon implants
(Wright Medical Technology, Memphis, TN), as described above [Figure 4]. Three months after this, he