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.
To study the recovery method and effect of amputated foot after temporary ectopic implantation. Methods Two male patients with amputated foot were treated with temporary ectopic implantation in July 2001 and January 2002. Amputated foot was caused by mechanical injury and crush injury. After 6 hours, temporary ectopic implantation of amputated foot was given and replantation was done 3 months after primary operation. The recovery methods were as follows: automatic and passive motion, high pressure oxygen, massage, protective and positional feel ing training, etc. The effects of recovery was observed. Results All amputated foots survived after operation, the time of follow-up was 6 years,and 5 years and 7 months. Extension degree of first metatarsal digital joint was 12º and 15º, flex degree of first metatarsal digital joint was 15º and 13º, and extension degree of other metatarsal digital joints was 8º and 9º. Force degree of extension muscle was 4, force degree of flex muscle was 4, and two-point discrimination was 20 mm and 18 mm. Patients recovered their superficial sensibil ity, touch sense, deep pain sense and topognosis. The skin color and temperature were normal. And the patients could do some housework. Conclusion Temporary ectopic implantation of amputated foot can recover the function of amputated foot by motor and sensitive recovery methods.
Objective To study the method of reinnervation after ectopic transplantation of the gracilis muscle in rats. Methods Sixty healthy male rats (age, 8 months; weight, 400-500 g) were randomly divided into 3 groups: the control group, the motor reinnervation group, and the sensory reinnervation group. The right gracilis of the rat was cut off, and the muscle was transplanted to the left leg. In the control group, no reinnervation was performed on the obturator nerve; in the sensory reinnervation group, the obturator nerve was coapted with the recipient saphenous nerve; in the motor reinnervation group, the obturator nerve was coapted with the femoral nerve motor branch. After 25 weeks, the weight of the muscle was measured, and the histological examination was performed. Results Atrophy of the gracilis was found to be a dominant effect in the control group, where the weight of the muscle was 204.0±15.3 mg. In the motor reinnervation group, the weight ofthemuscle was 394.8±12.9 mg, and in the sensory reinnervation group, it was 389.2±13.5 mg, with no significant difference between the two groups (P＞0.05). The weight of the muscle in the motor reinnervation group and in the sensory reinnervation group was significantly greater than that in the control group (P＜0.05).The tissue observation revealed that the nerve axon was diffusedin the motor reinnervated group, with no nerve endplates found. The motor nervereinnervated flaps showed the viable axons out to the motor endplates. The histological examination revealed evidence of reinnervation. Conclusion The motor or sensory nerve anastomosis after the ectopic transplantation of the skeletal muscle can prevent the atrophy of the muscle and restorepart of the nerve function.