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a b

c d e a b
Figure 3: (a) The proximal end of the left forearm; (b) the implanted Figure 4: Appearance 18 months after surgery. (a) Extension; (b) flexion
hand is dissected from the ectopic site; (c) the hand is amputated
from the ectopic site; (d and e) replantation is completed, (d) palmar
view; (e) dorsal view on matching the vessels between the recipient site and
the implanted part. In our case, a venous network on
Outcome evaluation the dorsum of the foot was presented, which can be
The hand survived with normal color and capillary included in the dorsalis pedis fasciocutaneous flap. In
refilling test, partial flap necrosis was noted, but healed the second‑stage foot‑to‑forearm transfer, the flap can
with wound care. Bone healing was achieved 4 months be transferred to the forearm along with the hand,
after the second operation. Eighteen months after without the need for additional vascular anastomosis.
surgery [Figure 4], two‑point discrimination on the pulps In our case, the flap provided sufficient room for the
of the first through fifth digits was 4, 6, 7, 5, and 8 mm, underlying tendons and nerves. We believe a groin
respectively. Tenolysis was not performed because the flap or superficial inferior epigastric artery flap may
patient refused. Tange of motion arcs for the first to be needed in other cases for which a larger space
fifth metacarpophalangeal joints were 5°, 10°, 4°, 0°, and may be needed to facilitate easier tendon and nerve
3°, respectively; for the proximal interphalangeal joints, reconstructions. In addition, physical therapy of the
2°, 5°, 2°, 3°, and 0°, respectively; and for the distal amputated parts before reattached to prevent joint
interphalangeal joints, 0°, 0°, 2°, 0°, and 0°, respectively. stiffness and tendon adhesions, the special needs at the
The patient reported no pain for the hand or forearm. secondary replantation, such as flaps for the coverage
[6]
The disability score for the arm, shoulder, and hand was soft tissue defects at the recipient site and patient
78. Based on a foot function assessment, the patient acceptance should also be considered.
[7]
reported no foot pain and had no difficulty when he Indications for temporary ectopic hand implantation are
stood on tiptoe or walked in the house. The patient had severe injuries on the proximal end of the limb where
no difficulty when he walked outside for four blocks, salvation of the hand in situ is difficult, and the distal part
climbed or descended stairs, got up from a chair, climbed is mildly injured. Contraindication is severe injured in the
curbs, ran, or walked quickly. distal part where revascularization is impossible.

DISCUSSION Function of the reattached parts can vary widely. As
these are severe and complex injuries, satisfactory
Since the first replant almost 52‑year‑ago, thousands results may not be attained in many patients. In such
of severed hands have been reattached, preserving the case, the inconvenience during the banking period
quality of life for these patients through improved function and inappropriateness of shoe wearing, especially in a
and appearance that the void remaining after amputation cold area, should be considered. In addition, the cost
[8]
cannot provide. Revascularization procedures are often is generally higher than that of direct replantation or
easier than replantation, but incomplete amputations with revascularization. Therefore, the benefits and risks should
an extensive crush‑avulsion injury may be more difficult be discussed carefully before undertaking these surgical
because debridement of nonviable tissue and bone reconstructions.
shortening cannot retain healthy structures. In such cases,
the percentage of viability is lower. Temporary ectopic REFERENCES
implantation offers an approach to detach the distal part
safely from the injured site, which improves subsequent 1. Ni G, Wu X, Zhang D, Yang H, Ma X, Sun X. Temporary ectopic implantation
of amputated fingers and dorsalis pedis flaps for thumb reconstruction
viability. [9] and skin defect repair of hands. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi
Several recipient sites are available for temporary ectopic 2013;27:1094‑7.(in Chinese)
implantation, including the groin, lower leg, foot, and 2. Godina M, Bajec J, Baraga A. Salvage of the mutilated upper extremity with
temporary ectopic implantation of the undamaged part. Plast Reconstr Surg
opposite arm and hand. [4‑7] Selection is generally based 1986;78:295‑9.
Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 45