Temporary Ectopic Implantation of a Single Finger Using a Perforator as a Feeding Vessel, and Subsequent Prefabricated Chimeric Flap Transplantation

Abstract

Objective: Ectopic implantation was first reported by Godina in 1986. We herein present 2 cases in which amputated fingers were salvaged and reconstructed by means of temporary ectopic implantation utilizing perforator anastomoses and chimeric flaps.

Methods: Case 1. A 30-year-old man injured his right hand. All of the fingers were completely crushed with the exception of the little finger. We performed an ectopic implantation by using the superficial circumflex iliac artery perforator. Three months later, the little finger was transplanted with the superficial circumflex iliac artery perforator flap, vascularized nerve, and the 2nd metacarpal bone. Case 2. A 29-year-old man suffered a degloving injury of the index finger. The digital artery was anastomosed to deep inferior epigastric artery perforator. One month later, a deep inferior epigastric artery perforator flap containing the ectopically transplanted index finger was transplanted, but the index fingertip became pale and necrotized. After debridement, a hemipulp transplantation was performed.

Results/conclusions: As the diameter of perforators is similar to that of digital arteries, and perforators are capable of supplying large areas of tissue, they can be used as recipient vessels for ectopic implantation in finger salvage procedures. Another advantage of perforators as feeding vessels in ectopic implantation is the possibility of forming an ectopic chimera; the finger can be incorporated as a part of the chimeric reconstructive flap. With respect to these advantages, the perforator can be used as a feeder in an ectopic implantation of single finger.

Figure 1

(a) Amputated little finger (arrow). (b) Left groin superficial circumflex iliac artery perforator (SCIP) (arrow). (c) Extopic chimeric flap design 3 months after ectopic implantation. (d) Chimeric SCIP flap with vascularized lateral femoral cutaneous nerve.

Figure 2

(a) Little finger 3 months after injury. (b) The right vascularized 2nd metacarpal bone was harvested on the 5th metacalpal bone for use as a proximal phalanx. (c) Amputated little finger with SCIP flap inset on the 2nd metacarpal bone. (d) Ectopic chimera transplantation. Nd indicates distal end of the 5th digital nerve; Np, proximal end of the 5th digital nerve; Nv, vascularized LFCN; Va, SCIA/SCIV; Vb, SIEA/SIEV; Vc, 5th common digital artery; Vd, subdermal vein.

Figure 3

(a) The distance between the thumb and the little finger was 10 cm. (b) He is able to hold and throw a ball comfortably as well as (c) hold a pen.

Figure 4

Amputation resulting from printing machine accident in a 29-year-old man. (a) The digital artery of the index finger was anastomosed to the deep inferior epigastric artery perforator (DIEP) at the level of the distal interphalangeal joint. (b) Computed tomographic angiography demonstrating connection between the DIEP and the digital artery. (c) Six months after ectopic implantation. (d) Grip position.