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Case Report Plastic and Aesthetic Research

Temporary ectopic hand implantation

Xu Zhang, Hong-Wei Zhu

Department of Hand Surgery, The Second Hospital of Qinhuangdao, Changli, Qinhuangdao 066600, Hebei, China.
Address for correspondence: Dr. Xu Zhang, Department of Hand Surgery, The Second Hospital of Qinhuangdao, Changli,
Qinhuangdao 066600, Hebei, China. E-mail: ahand@sina.com

ABSTRACT
Severe crushing injuries to the distal forearm can preclude immediate hand replantation, with
temporary ectopic implantation as a practicable option under special circumstances. This report
describes a case of temporary ectopic hand implantation for a crush injury extending from the wrist to
the middle third of the forearm, using the left foot as the recipient site. The hand was replanted onto
the left forearm 3 months after the ectopic implantation, with functional gains seen by 18 months.
Satisfactory ambulation was retained, with no reported foot pain. Temporary ectopic implantation is a
pragmatic alternative under select circumstances.
Key words:
Ectopic, hand, hand implantation, replantation, transplant

INTRODUCTION thumbs ectopically onto the forearm and foot in two
cases, the thumbs survived after second‑stage replantation
Severe crushing injuries to the distal forearm are and the patients regained function 4 months after surgery.
[5]
devastating and can preclude direct replantation for Tomlinson et al. implanted digits to the contralateral
salvage of the hand. In such difficult situations, temporary forearm, with subsequent reconstruction of the injured
ectopic implantation is a viable option under specific hand when combined with microvascular toe transfer.
circumstances. The amputated part, when transferred Their outcome was a functionally useful hand which could
[1]
to a healthy recipient site, allows the patient to recover be incorporated into daily life and a cosmetic appearance
from critical combined injuries, radical debridement, and preferable to that of amputation.
related soft tissue repairs. [2]
This report describes a case of temporary ectopic hand
Previous temporary ectopic implantations have been implantation. The left foot was used as the recipient site.
reported in the literature. Wang et al. reported two
[3]
cases of temporary ectopic implantation of complex CASE REPORT
amputated forearms, followed by successful replantation
to their anatomic positions in a second stage, the In May 14, 2010, a 35‑year‑old man sustained a machine
contralateral upper extremity was an acceptable recipient injury to his left forearm [Figure 1]. The patient was
site for temporary ectopic implantation. For subsequent consented for this technique. Physical examination
replantation, a cross‑arm flap was designed to carry the revealed a severe crushing injury that extended from
vascular pedicle from the ectopic implantation recipient the wrist to the middle third of the forearm, with
to improve blood supply to the replanted part upon contamination and associated comminuted fractures. The
replantation to the original site and with when the blood remaining connecting tissues included the median and
supply was re‑established. Li et al. temporarily implanted ulnar nerves, several flexor tendons, and a strip of skin
[4]
with a severe contusion.
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Quick Response Code: Proximal end management
Website: Surgery was performed under axillary block and epidural
www.parjournal.net
anesthesia with pneumatic tourniquet control. Two surgical
teams worked simultaneously. The limb was transected at
DOI: the level of the radiocarpal joint [Figure 2a and b]. The
10.4103/2347-9264.149381 proximal end of the forearm was debrided thoroughly, but
was preserved as long as possible. The median and ulnar

Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 43