Abdominal pocketing for the child’s fingers for hand replantation: A clinical case

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BACKGROUND: The traumatic avulsion of fingers is a severe injury that requires emergency replantation. In the case of crush mechanism and degloving, direct vessel repair, and reconstruction may be impossible. It appears fair to use indirect revascularization by enveloping the phalanges after osteosynthesis with blood-supplied tissues. The most accessible anatomically and functionally are the lower abdominal flap and abdominal pocketing of the hand; the flap pedicle was cut and the hand was released. Staged surgeries could be required for functional and aesthetic reconstruction of acceptable soft tissue envelop of the hand.

CLINICAL CASE: This is a clinical case of successful treatment of traumatic avulsion of II, III, IV fingers on the right hand by phalanx osteosynthesis and abdominal pocketing. The restoration of the functionally and aesthetically acceptable finger was achieved.

DISCUSSION: There is a high risk of necrosis and stump formation after the replantation of severely injured fingers when there was any possibility for direct vessel repair. Another method is the indirect revascularization by blood vessel ingrowth from the flap through the fracture line. This saves the injured limb segment.

CONCLUSIONS: The presented technique of abdominal pocketing allows the replantation of the avulsed and degloved fingers without microsurgical vascular operation and restores them. It appears fair to recommend this technique as a salvage surgery in the case of severely injured soft tissues of the avulsed hand fingers.

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About the authors

Sergey B. Bogdanov

Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1; Kuban State Medical University

Author for correspondence.
Email: bogdanovsb@mail.ru
ORCID iD: 0000-0001-9573-4776
SPIN-code: 2465-5462
Scopus Author ID: 57202018252

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Krasnodar; Krasnodar

Andrey M. Aristov

Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1

Email: aristovam23@mail.ru
ORCID iD: 0000-0001-6202-0590

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Krasnodar

Sergey N. Kurinnyy

Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1; Kuban State Medical University

Email: kurin425@mail.ru
ORCID iD: 0000-0002-8780-5308
SPIN-code: 4181-9484

MD, PhD student

Russian Federation, Krasnodar; Krasnodar

Vladislav A. Nikishev

City Hospital Resort-City Gelendzhik

Email: vanik87rus@mail.ru
ORCID iD: 0000-0002-8022-8368
Russian Federation, Gelendzhik, Krasnodar region

Mikhail L. Mukhanov

Kuban State Medical University

Email: puttiinn@mail.ru
ORCID iD: 0000-0002-9061-6014
SPIN-code: 3684-9725

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Krasnodar

Anastasia L. Vedeneeva

Kuban State Medical University

Email: alvedeneeva@gmail.com
ORCID iD: 0000-0001-7353-5426


Russian Federation, Krasnodar


  1. Bunnell S. Surgery of the hand. 3rd edition. Philadelphia, Montreal: J.B. Lippincott Co.; 1956.
  2. Belousov AE. Plasticheskaya, rekonstruktivnaya i esteticheskaya khirurgiya. Saint Petersburg: Gippokrat; 1998. (In Russ.)
  3. Shim H-S, Kim D-H, Kwon H, Jung S-N. Contralateral abdominal pocketing in salvation of replanted fingertips with compromised circulation. The Scientific World Journal. 2014;2014:548687. doi: 10.1155/2014/548687
  4. Kim KS, Eo SR, Kim DY, et al. A new strategy of fingertip reattachment: Sequential use of microsurgical technique and pocketing of composite graft. Plast Reconstr Surg. 2001;107(1)73–79. doi: 10.1097/00006534-200101000-00012
  5. Lin T-S, Jeng S-F, Chiang Y-C. Fingertip replantation using the subdermal pocket procedure. Plast Reconstr Surg. 2004;113(1):247–253. doi: 10.1097/01.PRS.0000095950.31223.09
  6. Sabapathy SR, Venkatramani H, Playa PM. The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand. Trauma Case Reports. 2015;1(3–4):25−31. doi: 10.1016/j.tcr.2015.08.001
  7. Goertz O, Kapalschinski N, Daigeler A, et al. The effectiveness of pedicled groin flaps in the treatment of hand defects: results of 49 patients. J Hand Surg Am. 2012;37(10):2088–2094. doi: 10.1016/j.jhsa.2012.07.014
  8. Nazerani S, Motamedi MHK, Nazerani T, Bidarmaghz B. Treatment of traumatic degloving injuries of the fingers and hand: introducing the ‘compartmented abdominal flap’. Tech Hand Up Extrem Surg. 2011;15(3):151–155. doi: 10.1097/BTH.0b013e3182051c02
  9. Al-Qattan MM, Alammar AK, Alfaqeeh FA, et al. Pedicled abdominal flaps for hand reconstruction in adults: Physiotherapy of the attached hand. Plastic and Reconstructive Surgery Global Open. 2021;9(3):3474. doi: 10.1097/GOX.0000000000003474

Supplementary files

Supplementary Files
1. Fig. 1. Patient’s hand on admission at the primary healthcare facility

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2. Fig. 2. Osteosynthesis of the disconnected phalanges of fingers II–IV with Kirschner wires

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3. Fig. 3. Abdominal pocketing: implantation of the replanted fingers in a pocket under the graft of the anterior abdominal wall

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4. Fig. 4. Acute flap training

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5. Fig. 5. View of the palmar surface of the fingers after excision of the abdominal flap

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6. Fig. 6. Skin defect along the palmar surface of reconstructed fingers II–IV

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7. Fig. 7. Plastic replacement of the defect of the palmar surface of fingers II–IV with a free split skin autograft

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8. Fig. 8. Radiogram of the hand 2.5 months after surgery

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9. Fig. 9. View of the hand dorsum after the elimination of iatrogenic syndactyly of fingers II–IV

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10. Fig. 10. View of the palmar surface of the hand after the elimination of iatrogenic syndactyly of fingers II–IV

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11. Fig. 11. Radiogram of the hand by the time that iatrogenic syndactyly of fingers II–IV was removed

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12. Fig. 12. View of the hand where sutures were removed after the elimination of iatrogenic syndactyly was completed

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Copyright (c) 2022 Bogdanov S.B., Aristov A.M., Kurinnyy S.N., Nikishev V.A., Mukhanov M.L., Vedeneeva A.L.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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