From Devastation to Function : A Comprehensive Reconstructive Approach to High-Energy Hand Trauma with Multiple Amputated Digits - 01/10/26

Doi : 10.1016/j.hcl.2026.06.006

Luigi Troisi, MD, PhD, FEBOPRAS ^a,^b,^⁎ , Francesco Zanchetta, MD ^a, Giorgio Eugenio Pajardi, MD ^a,^b

^a Reconstructive Microsurgery Service, University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy

^b School of Specialisation in Plastic, Reconstructive and Aesthetic Surgery, University of Milan “La Statale”, Milan, Italy

^∗ Corresponding author. School of Specialisation in Plastic, Reconstructive and Aesthetic Surgery, University of Milan “La Statale”, Milan, Italy. School of Specialisation in Plastic, Reconstructive and Aesthetic Surgery University of Milan “La Statale” Milan Italy

Resumen

This case report describes the successful multistage reconstruction of a severely mangled hand in a 15-year-old boy following a firecracker explosion. The injury resulted in multiple digit amputations, complex fractures, extensive soft tissue loss, and damage to critical anatomic structures, sparing only the little finger. Initial management focused on debridement, skeletal stabilization, and soft tissue coverage, followed by a carefully planned reconstructive pathway. Key surgical interventions included a medial plantar free flap for glabrous, sensate coverage of the thumb, a second toe transfer to restore opposition and prehension, and distraction osteogenesis of the first metacarpal to improve thumb length and fine pinch.

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Keywords : Mangled hand, Blast injury, Bone lengthening, Free flap, Multiple digit amputation, Toe to hand, Toe transfer, Medial plantar flap