{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T07:19:03Z","timestamp":1780816743899,"version":"3.54.1"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital replantation of the available remnants may not adequately restore the hand function. In such cases, heterotopic digital replantation may provide a more functional reconstruction.<\/jats:p><jats:p>\n          Methods\u2003Between 1997 and 2018, 53 patients with mutilating hand injuries were treated with heterotopic digital replantation at our institution. A retrospective chart review was conducted to determine the details of the injury, indications for heterotopic digital replantation, and functional outcomes.<\/jats:p><jats:p>\n          Results\u2003In total, 173 digits were amputated from 53 patients (one patient suffered from bilateral hand injuries, so totally 54 hands). Sixty-eight digits underwent heterotopic digital replantation, 30 digits had orthotopic digital replantation, and 75 stumps were terminalized. The survival rate of digits treated by heterotopic digital replantation and orthotopic digital replantation was 83.8% (57\/68) and 86.7% (26\/30), respectively (p\u2009=\u20091). Tripod grip was achieved in 83.3% (45\/54) of patients following replantation and optional secondary reconstructive surgeries.<\/jats:p><jats:p>\n          Conclusion\u2003Heterotopic digital replantation is a practical and reliable method for achieving optimal hand function following mutilating hand injuries. The basic principles are to restore a functional thumb in the first instance, followed by at least two adjacent fingers against which the thumb can oppose. This method is particularly indicated when orthotopic digital replantation of the available amputated parts would yield a suboptimal result.<\/jats:p>","DOI":"10.1055\/s-0043-1761288","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T23:44:07Z","timestamp":1675208647000},"page":"573-580","source":"Crossref","is-referenced-by-count":10,"title":["Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review"],"prefix":"10.1055","volume":"39","author":[{"given":"Tommy Nai-Jen","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Chen","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hywel","family":"Dafydd","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil S.","family":"Sachanandani","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6803-7174","authenticated-orcid":false,"given":"Lisa Wen-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chieh","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Te","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1097\/00006534-199710000-00020","article-title":"The \u201cTic-Tac-Toe\u201d classification system for mutilating injuries of the hand","volume":"100","author":"J Weinzweig","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.bjps.2007.02.019","article-title":"Severe mutilating injuries to the hand: guidelines for organizing the chaos","volume":"60","author":"F del Pi\u00f1al","year":"2007","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/BF01675636","article-title":"The contributions of microvascular surgery to emergency hand surgery","volume":"15","author":"H J Buncke","year":"1991","journal-title":"World J Surg"},{"issue":"S 03","key":"ref4","first-page":"S214","article-title":"Indications and contraindications of digital replantation [in Japanese]","volume":"91","author":"H Y Chiu","year":"1992","journal-title":"J Formos Med Assoc"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0020-1383(99)00196-5","article-title":"Results of 1018 digital replantations in 552 patients","volume":"31","author":"S Waikakul","year":"2000","journal-title":"Injury"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/00006534-199701000-00019","article-title":"Metacarpal hand: classification and guidelines for microsurgical reconstruction with toe transfers","volume":"99","author":"F C Wei","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0749-0712(02)00137-3","article-title":"Replantation in the mutilated hand","volume":"19","author":"B J Wilhelmi","year":"2003","journal-title":"Hand Clin"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/00005373-198505000-00013","article-title":"Transpositional digital replantation","volume":"25","author":"H Y Chiu","year":"1985","journal-title":"J Trauma"},{"key":"ref9","first-page":"223","article-title":"Microsurgical transfer of avulsed index finger to degloved thumb - a case report","volume":"26","author":"C H Lin","year":"1993","journal-title":"J Surg Assoc ROC"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1002\/micr.1920150707","article-title":"Transpositional microsurgery in multiple digital amputations","volume":"15","author":"P N Soucacos","year":"1994","journal-title":"Microsurgery"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/01.SAP.0000037269.62980.69","article-title":"Heterotopic replantation in mutilating hand injury","volume":"50","author":"P C An","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1097\/PRS.0000000000001721","article-title":"Heterotopic procedures in mutilating hand injuries: a synopsis of essential reconstructive tools","volume":"136","author":"E Kokkoli","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref13","first-page":"185","article-title":"Value of heterotopic finger replantation [in German]","volume":"64","author":"P Brenner","year":"1993","journal-title":"Chirurg"},{"issue":"08","key":"ref14","first-page":"18","article-title":"Heterotopic replantation of fingers after traumatic amputation [in Russian]","volume":"\u2022\u2022\u2022","author":"N O Milanov","year":"1999","journal-title":"Khirurgiia (Mosk)"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/02844319950159523","article-title":"Transpositional replantation of digits. Case reports","volume":"33","author":"A H Schwabegger","year":"1999","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.2106\/JBJS.CC.N.00126","article-title":"Heterotopic transarticular replantation: a functional reconstruction design for a mutilated hand with multiple digit involvement","volume":"5","author":"M S Engin","year":"2015","journal-title":"JBJS Case Connect"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/S0094-1298(20)31316-X","article-title":"Microsurgical reconstruction of opposable digits in mutilating hand injuries","volume":"16","author":"F C Wei","year":"1989","journal-title":"Clin Plast Surg"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0749-0712(02)00143-9","article-title":"Use of \u201cspare parts\u201d in mutilated upper extremity injuries","volume":"19","author":"R E Brown","year":"2003","journal-title":"Hand Clin"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/micr.20921","article-title":"Remote real-time monitoring of free flaps via smartphone photography and 3G wireless Internet: a prospective study evidencing diagnostic accuracy","volume":"31","author":"H Engel","year":"2011","journal-title":"Microsurgery"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1097\/00006534-200110000-00007","article-title":"The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?","volume":"108","author":"F C Wei","year":"2001","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1055\/s-0033-1360584","article-title":"Challenges in measuring outcomes following digital replantation","volume":"27","author":"S J Sebastin","year":"2013","journal-title":"Semin Plast Surg"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/17453679509157156","article-title":"Mid-palm replantation. Long-term results","volume":"264","author":"N Gerostathopoulos","year":"1995","journal-title":"Acta Orthop Scand Suppl"},{"issue":"S 01","key":"ref23","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/SAP.0000000000000712","article-title":"Heterotopic vascularized joint transfer in mutilating hand injuries","volume":"76","author":"N J Chang","year":"2016","journal-title":"Ann Plast Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1761288.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T23:23:40Z","timestamp":1691450620000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1761288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":23,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2023,8,7]]},"published-print":{"date-parts":[[2023,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1761288","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}