Complex Hand Reconstruction using a Novel Two-stage Temporary Ectopic Implantation of the Contralateral Upper Limb

Abstract

Ectopic transplantation of the hand remains a rare, innovative yet valuable operation in select cases of trauma and amputation. We aim to describe a novel technique of complex hand reconstruction using a two-stage ectopic implantation of the contralateral upper limb. A male patient with a near complete avulsion amputation of the right upper limb at the level of the mid-forearm and a crushing injury to his left hand was admitted after a farming accident. The right palm was ectopically transplanted to the left lower limb and both upper limbs underwent debridement with vacuum assisted dressings (VACs). There was eventual dieback of the left thumb, ring and little finger with a large palmar soft tissue defect that was eventually reconstructed using segments of the ectopically transplanted limb in two separate operations. The patient made an uneventful postoperative recovery and managed to regain protective sensation and gross motor function of his reconstructed hand.

Keywords: Complex hand reconstruction; Ectopic transplant; Extremities; Microsurgical reconstruction; Mutilating hand injuries; Traumatic.

FIGURE 1

(A) Clinical photo showing the near complete avulsion amputation of the right upper limb at the level of mid forearm. (B). Clinical photo showing the severe crush injury of the left hand with varying levels of amputation of the thumb, ring, and little fingers.

FIGURE 2

(A) Clinical photo showing the ectopic transplantation of the right hand close to the left medial malleolus. (B). Xray showing K wire fixation of the amputated hand to the tibia.

FIGURE 3

(A) Clinical photo showing preparation of the left ring and little fingers stumps after their revision amputations. (B) Clinical photo showing the reconstructed ring and little fingers using the ring and little fingers from the ectopically transplanted right hand. (C) Clinical photo showing the remaining ectopic transplanted right hand after harvesting the right and little fingers.

FIGURE 4

CT angiography performed prior to reconstruction, which demonstrated good flow between the ulnar and proximal end of the posterior tibial artery but lack of flow between the radial and posterior tibial artery.

FIGURE 5

(A) Clinical photo showing the preparation of the ectopic thumb for transplantation and the recipient bed. (B) Clinical photo showing the final reconstruction.

FIGURE 6

Clinical photographs showing the function of the patient's reconstructed left hand at 1 year. (A) In grasp. (B) In release.