TEMPORARY ECTOPIC IMPLANTATION OF AMPUTATED FINGERS AND DORSALIS PEDIS FLAPS FOR THUMB RECONSTRUCTION AND SKIN DEFECT REPAIR OF HANDS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NI Guohua ^1,2 , WU Xuejian ¹ , ZHANG Dehong ² , YANG Honghai ² , MA Xuetao ² , SUN Xiaohang ²

1Department of Orthopedics, the First Affiliated Hospital, Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;;
2Department of Orthopedics, the 91th Hospital of Chinese PLA. Corresponding author: WU Xuejian, E-mail: wuxuejianzz@126.com;

Corresponding author：

Keywords：

Thumb amputation; Ectopic implantation; Thumb reconstruction; Dorsalis pedis flap; Wound repair

DOI：

10.7507/1002-1892.20130239

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Objective To investigate the feasibility of temporary ectopic implantation of amputated fingers and dorsalis pedis flaps for thumb reconstruction and skin defect repair of the hand. Methods Between February 2006 and February 2012, 9 patients with thumb amputation having no replanted condition were treated. There were 7 males and 2 females with an average age of 35 years (range, 20-45 years). The injury causes included explosive injury in 1 case, puncher injury in 1 case, stiring machine injury in 1 case, gear injury in 3 cases, and heavy pound injury in 3 cases. At 2-5 hours after injury, one-stage temporary ectopic implantation of amputated finger to foot was performed. After debridement, thumb defect was rated as degree III in 1 case, as degree IV in 3 cases, and as degree V in 5 cases. When amputated fingers survived completely after 1-4 months, the amputated finger was replanted to its anatomic position, skin defect was repaired with dorsalis pedis flap. The area of skin defect ranged from 5 cm × 4 cm to 7 cm × 6 cm. The area of flaps ranged from 6 cm × 5 cm to 8 cm × 7 cm. The donor site was repaired by the skin grafting. Results Arterial crisis occurred in 1 case after 1 day of one-stage operation, and was cured after vascular exploration, and the amputated fingers survived in the others. The reconstructed thumbs and flaps survived after two-stage operation, and the skin graft at donor site survived. The patients were followed up 1-4 years (mean, 2.8 years). The reconstructed thumbs had good appearance and satisfactory opposition and finger-to-finger functions. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the scores of survival fingers were 73-91 (mean, 84); the results were excellent in 7 cases and good in 2 cases with an excellent and good rate of 100%. Conclusion Temporary ectopic implantation of amputated finger to foot combined with dorsalis pedis flap can be used to reconstruct thumb and repair skin defect of the hand.

Citation： NI Guohua,WU Xuejian,ZHANG Dehong,YANG Honghai,MA Xuetao,SUN Xiaohang. TEMPORARY ECTOPIC IMPLANTATION OF AMPUTATED FINGERS AND DORSALIS PEDIS FLAPS FOR THUMB RECONSTRUCTION AND SKIN DEFECT REPAIR OF HANDS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(9): 1094-1097. doi: 10.7507/1002-1892.20130239 Copy

1.	倪国骅, 徐世保, 杨红海, 等. 爆炸伤断指远位寄养二期回植一例. 中华手外科杂志, 2007, 23(5): 318.
2.	倪国骅, 徐世保, 张德洪, 等. 远位寄养指回植再造拇指. 中华创伤骨科杂志, 2011, 13(2): 193-194.
3.	Li J, Ni GH, Guo Z, et al. Salvage of amputated thumbs by temporary ectopic implantation. Microsurgery, 2008, 28(7): 559-564.
4.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
5.	周明武, 李坤德, 谢昌平, 等. 特殊类型断肢(指)再植的临床研究. 中华手外科杂志, 1997, 13(4): 218-220.
6.	Graf P, Gröner R, Hörl W, et al. Temporary ectopic implantation for salvage of amputated digits. Br J Plast Surg, 1996, 47(3): 174-177.
7.	何旭, 程国良, 刘亚平, 等. 用量化指标探讨断指再植的适应证. 中华显微外科杂志, 2004, 27(3): 177-179.
8.	洪建军, 高伟阳. 复杂断指(肢)的远位寄生及二期再植. 中华显微外科杂志, 2001, 24(1): 63-64.
9.	王杰锋, 李黎明, 孙煜杰, 等. 离断拇指异位寄养二期回植1例报告. 实用骨科杂志, 2007, 13(4): 253-254.
10.	李展新, 徐基农, 夏霆, 等. 足背寄养指回植1例. 实用手外科杂志, 2007, 21(1): 18.
11.	Godina M, Bajec J, Baraga A. Salvage of the mutilated upper extremity with temporary ectopic implantation of the undamaged part. Plast Reconstr Surg, 1986, 78(3): 295-299.
12.	丘奕军, 陈保光, 王昌成, 等. 断臂寄生大腿及二期再植一例报告. 中华创伤骨科杂志, 2002, 4(1): 77-78.
13.	寿奎水. 足趾移植再造拇手指失败病例分析. 中华手外科杂志, 2006, 22(1): 8-10.
14.	Mangus DJ. Temporary ectopic implantation. J Hand Surg (Am), 1991, 16(6): 1151.
15.	王江宁, 童致虹, 张铁慧, 等. 暂时性异位断足寄养再回植术. 中国修复重建外科杂志, 2003, 17(1): 46-49.
16.	倪国骅, 张德洪, 徐世保, 等. 离断拇指的寄养与二期回植2例报道. 实用手外科杂志, 2009, 23(2): 123-124.

1. 倪国骅, 徐世保, 杨红海, 等. 爆炸伤断指远位寄养二期回植一例. 中华手外科杂志, 2007, 23(5): 318.
2. 倪国骅, 徐世保, 张德洪, 等. 远位寄养指回植再造拇指. 中华创伤骨科杂志, 2011, 13(2): 193-194.
3. Li J, Ni GH, Guo Z, et al. Salvage of amputated thumbs by temporary ectopic implantation. Microsurgery, 2008, 28(7): 559-564.
4. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
5. 周明武, 李坤德, 谢昌平, 等. 特殊类型断肢(指)再植的临床研究. 中华手外科杂志, 1997, 13(4): 218-220.
6. Graf P, Gröner R, Hörl W, et al. Temporary ectopic implantation for salvage of amputated digits. Br J Plast Surg, 1996, 47(3): 174-177.
7. 何旭, 程国良, 刘亚平, 等. 用量化指标探讨断指再植的适应证. 中华显微外科杂志, 2004, 27(3): 177-179.
8. 洪建军, 高伟阳. 复杂断指(肢)的远位寄生及二期再植. 中华显微外科杂志, 2001, 24(1): 63-64.
9. 王杰锋, 李黎明, 孙煜杰, 等. 离断拇指异位寄养二期回植1例报告. 实用骨科杂志, 2007, 13(4): 253-254.
10. 李展新, 徐基农, 夏霆, 等. 足背寄养指回植1例. 实用手外科杂志, 2007, 21(1): 18.
11. Godina M, Bajec J, Baraga A. Salvage of the mutilated upper extremity with temporary ectopic implantation of the undamaged part. Plast Reconstr Surg, 1986, 78(3): 295-299.
12. 丘奕军, 陈保光, 王昌成, 等. 断臂寄生大腿及二期再植一例报告. 中华创伤骨科杂志, 2002, 4(1): 77-78.
13. 寿奎水. 足趾移植再造拇手指失败病例分析. 中华手外科杂志, 2006, 22(1): 8-10.
14. Mangus DJ. Temporary ectopic implantation. J Hand Surg (Am), 1991, 16(6): 1151.
15. 王江宁, 童致虹, 张铁慧, 等. 暂时性异位断足寄养再回植术. 中国修复重建外科杂志, 2003, 17(1): 46-49.
16. 倪国骅, 张德洪, 徐世保, 等. 离断拇指的寄养与二期回植2例报道. 实用手外科杂志, 2009, 23(2): 123-124.

Chinese Journal of Reparative and Reconstructive Surgery

TEMPORARY ECTOPIC IMPLANTATION OF AMPUTATED FINGERS AND DORSALIS PEDIS FLAPS FOR THUMB RECONSTRUCTION AND SKIN DEFECT REPAIR OF HANDS

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