Microvascular free on-top plasty in a mutilated hand.

Amputation of the index, middle, and ring fingers leaves a poor, unstable pinch and grasp between the thumb and little finger. In this type of mutilated hand, it is necessary to reconstruct one or two fingers for firm chuck pinch and good grasp. Functionally and cosmetically, toe transfer is superior to other methods of finger reconstruction because of its mobility, sensibility, pulp size, and nail availability. However, a transfer from the foot may not always be available. In such a case, any finger stump may be considered as a possible donor finger. The authors performed a microvascular free transfer of the remaining portion of the ring finger including the metacarpophalangeal joint to the top of the remaining portion of the index finger in a mutilated hand with intact thumb and little finger because the patient declined toe transfer. Postoperatively, more effective strength and stability, provided by three converging digits, was achieved in the hand. Accordingly, it was easier for the patient to grip small and large objects. The authors describe this procedure as a microvascular free on-top plasty.