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DOI: 10.1055/s-0043-1778080
Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm
Funding None.
Abstract
Background Extensive crush injuries to forearm pose a unique problem where replantation of uninjured hands to the forearm is not immediately possible due to difficulties in delineating tissue necrosis. Ectopic hand implantation preserves the hand and allows replanting the hand back to the forearm stump, but the tissues preserved in the stump could be inadequate to provide good hand function. In these subsets of cases, forearm reconstruction with composite flaps may offer a better chance of getting good hand function.
Methods We present a case of a 29-year-old male, a left-handed factory worker, with severe crushing of the left forearm by a hydraulic pressing machine with a relatively undamaged hand. A three-staged reconstruction was done with the recovery of the left hand after below elbow amputation and replanted to the left lower third of leg. Then a neo-forearm was reconstructed using a functioning free fibula, vastus lateralis muscle, and anterolateral thigh skin flap. Finally, the ectopically banked hand was returned to the reconstructed neo forearm.
Results After 2 years follow-up, protective sensation and grip strength of 2 pounds had developed in the hand. The disabilities of arm, shoulder, and hand score was 21, and he was able to perform multiple tasks using the left hand independently and as an assistive hand.
Conclusion The consensus on indications of ectopic banking is still open for debate. The addition of our ectopic replantation technique followed by neo-forearm reconstruction and replantation of the hand into the reconstructed neo-forearm, which is a novel concept, will broaden the horizon of reconstructive paradigm.
Note
This paper was presented at APSICON 2021(Won PEET prize) and WSRM 2022 (Won Best Case)
Authors' Contributions
Raja Tiwari conceptualized and visualized the study. Suvashis Dash and Raja Tiwari were involved in data curation and methodology. Suvashis Dash, Raja Tiwari, Shashank Chauhan, and Shivangi Saha helped in formal analysis. Maneesh Singhal and Raja Tiwari were involved in project administration. Raja Tiwari, Misha Ahir, and Suvashis Dash wrote the original draft. Shashank Chauhan, Maneesh Singhal, and Shivangi Saha reviewed and edited the manuscript.
Ethical Approval
The authors declare that the procedures were followed according to the regulations established by the Clinical Research and Ethics Committee and to the Helsinki Declaration of the World Medical Association.
Publication History
Received: 23 March 2023
Accepted: 20 September 2023
Article published online:
30 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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