Digital Salvage by Transposing Adjacent Ray Components

Background: Ballistic hand injuries often devastate bone and soft tissue and may ultimately require debridement of critical structures. Long-term hand function is frequently compromised as a result of distorted anatomy. Careful assessment at the time of injury affords the opportunity to critically appraise the anatomy and creatively design a reconstructive strategy. Methods: Herein we describe 2 cases of gunshot injuries to the hand that resulted in devastation to adjacent yet opposing metacarpal and phalangeal joint surfaces. Our reconstructive strategy aimed to maximize hand function by preserving undamaged tissue and transposing adjacent ray components. Results: In both instances, our patients' reconstructive surgeries resulted in acceptable cosmesis and improved functional outcome relative to more traditional approaches to these ballistic injuries. Conclusions: Our experience shows that a creative appraisal of devastating hand injuries allows for unique reconstructive strategies. Our cases further demonstrate the utility of transposing adjacent ray components to reconstruct digital mobility and hand function.