Free vascularized joint transfer from the nonreplantable digit as a free flap for primary reconstruction of complex hand injury.

We report our experience in treating a a patient with an electrical saw injury to the right hand that resulted in incomplete amputation of the ring and small fingers at the metacarpophalangeal (MCP) joint with segmental tissue loss. Ray amputation of the small finger was performed because of extensive tissue loss. The proximal interphalangeal joint of the nonreplantable small finger was transferred as a fillet flap for primary reconstruction of the severely damaged MCP joint of the ring finger after revascularization. Two years after surgery active range of motion of the reconstructed MCP joint was 35 degrees extension to 85 degrees flexion with no instability or pain.