A functional “metacarpal-hand” after a firework injury obtained without any flap or toe-transfer.

A functional “metacarpal-hand” after a firework injury obtained without any flap or toe-transfer.


  • Marco D'Orio a:1:{s:5:"en_US";s:95:"Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.";} https://orcid.org/0000-0002-5569-8210
  • Giuseppe Taccardo
  • Marco Passiatore
  • Giulia Macrì
  • Marta Starnoni
  • Rocco De Vitis


Fireworks, mangled extremities, hand, reconstructive surgery, bone graft.


A 37-year old male patient with a right-hand firework injury. An extreme hand reconstruction was performed. The second and third rays were sacrificed enlarging the first space. The diaphysis of the second metacarpal bone became a tubular graft to reconstruct the fourth metacarpal. The thumb consisted only in the first metacarpal bone. The result was satisfactory, according to the wishes and needs of the patient, a three-finger hand with an opposable thumb, obtained in only one surgical treatment and without using free flaps. The concept of an “acceptable hand” is related to the surgeon’s and patient’s opinions.


Ortiz R, Ozkan S, Chen NC, Eberlin KR. Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization. Hand (N Y) 2020 Nov;15(6): 831–6.

Sandvall BK, Keys KA, Friedrich JB. Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types. J Hand Surg Am 2017; 42(5): 385.e1-385.e8.

Del Pinal F. Severe mutilating injuries to the hand: guidelines for organizing the chaos. J Plast Reconstr Aesthet Surg 2007; 60(7): 816–27.

Matheron A-S, Hendriks S, Facca S, Liverneaux PA. Hand injuries due to firework devices: a series of 58 cases. Chir Main 2014; 33(2): 124–9.

Kurt Oktay KN, Akpinar P, Unlu Ozkan F, Aktas I, Ersoy Canillioglu Y, Erkanli Senturk G. The Effect of Alpha Lipoic Acid on the Recovery of Sciatic Nerve Injury in Rats: A Prospective Randomized Controlled Trial. Am J Phys Med Rehabil 2021; 100(8): 780-9.

Passiatore M, Perna A, De-Vitis R, Taccardo G. The Use of Alfa-Lipoic Acid-R (ALA-R) in Patients with Mild-Moderate Carpal Tunnel Syndrome: A Randomised Controlled Open Label Prospective Study. Malays Orthop J 2020; 14(1): 1-6.

Passiatore M, De Vitis R, Cilli V et al. The Italian Version of the Michigan Hand Outcomes Questionnaire (MHQ): Translation, Cross-Cultural Adaptation and Validation. J Hand Surg Asian-Pacific Vol 2021; 26(4): 666-83.

Padua R, Padua L, Ceccarelli E, et al. Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg Br 2003; 28(2): 179–86.

De Vitis R, Passiatore M, Cilli V, Maffeis J, Milano G, Taccardo G. Intramedullary nailing for treatment of forearm non-union: Is it useful? - A case series. J Orthop 2020; 20:97–104.

Cherubino M, Corno M, Valdatta L, Adani R. Thumb Reconstruction With Thin Proximal Ulnar Perforator Free Flap. J Hand Surg Am 2017; 42(2): e133–8.

Losco L, Kaciulyte J, Delia G, et al. Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation. J Invest Surg 2021; 34(6): 595-600.

Cherubino M, Valdatta L, Tos P, et al. Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures. J Reconstr Microsurg. 2017; 33 Suppl 1: S8-13.

Cherubino M, Scamoni S, Pellegatta I, Maggiulli F, Minuti A, Valdatta L. Massive de-gloving thigh injury treated by vacuum therapy, dermal regeneration matrix and lipografting. Afr J Paediatr Surg 2013; 10(4): 386–9.

Delia G, Battaglia F, Colonna MR, Barresi V, d’Alcontres FS. Is the adipofascial flap the key to regenerative surgery? JPRAS open. 2018; 31(18):49–58.




How to Cite

A functional “metacarpal-hand” after a firework injury obtained without any flap or toe-transfer. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 Jun. 13];94(S2):e2023085. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/13686

Most read articles by the same author(s)