The clinical scenario and images depict a through the palm amputation with the digits intact. The injury is a clean amputation with minimal avulsion. Thus, anatomic replantation of the entire hand is indicated. Digit transposition refers to using the salvageable digits and replanting them on the functionally important positions in the hand. Transpositional replantation is not indicated in the above scenario and would be more appropriate for a multidigit amputation as shown in Illustration A.
Soucacos et al reviewed their results of transpositional digital microsurgery in 34 patients. They found that transposition of a digit to the most functional part of the hand lead to a 2-point discrimination of 10-14mm in transposed digits and equivalent functionality of transposed digits with anatomically replanted digits.
Schwabegger et al presented a case series of 13 patients with multiple digit amputations. The primary goal of surgery was function and secondly, cosmesis. They found the results of transpositional replantation similar to conventional replantation.
Soucacos PN, Beris AE, Malizos KN, Vlastou C, Soucacos PK, Georgoulis AD. Transpositional microsurgery in multiple digital amputations. Microsurgery. 1994;15(7):469-73.
PMID:7968476 (Link to Abstract)
Schwabegger AH, Harpf C, Rumer A, Hussl H, Anderl H, Ninkovic MM. Transpositional replantation of digits. Case reports. Scand J Plast Reconstr Surg Hand Surg. 1999 Jun;33(2):243-9.
PMID:10450584 (Link to Abstract)