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[Temporary ectopic implantation of amputated fingers and dorsalis pedis flaps for thumb reconstruction and skin defect repair of hands].

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 x 4 cm to 7 cm x 6 cm. The area of flaps ranged from 6 cm x 5 cm to 8 cm x 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.