Temporary ectopic implantation for salvaging amputated parts: A systematic review

Tu, Yiji; Lineaweaver, William C.; Culnan, Derek M.; Bitz, Genevieve H.; Jones, Kyler J; Zhang, Feng

doi:10.1097/ta.0000000000001817

Cited by 15 publications

(8 citation statements)

References 24 publications

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“…5 13 Zhang et al reported results 18 months after surgery and his patients had two-point discrimination on the pulps of the first through fifth digits of 4, 6, 7, 5, and 8 mm, respectively. 14 The patient reported no pain in the hand or forearm and the disability score for the arm, shoulder, and hand was 78. In our case, the sensory recovery was reasonable and the motor recovery was significantly better.…”

Section: Discussionmentioning

confidence: 96%

“…Most of the ectopic replantation was performed in two stages; in our case one additional stage was required as the neo-forearm reconstruction was done. 13 14 15…”

Section: Discussionmentioning

confidence: 99%

“…Most of the ectopic replantation was performed in two stages; in our case one additional stage was required as the neo-forearm reconstruction was done. [13][14][15] Fixation of the replantation by external fixators, cross Kirschner wires (K-wires), and compression plates has been described. For major replantation, compression plates are a better choice for their durability as well as load-bearing capacity, [13][14][15] while K-wires are easy to apply and procedures can be done very quickly, these have less stability compared with plates.…”

Section: Discussionmentioning

confidence: 99%

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Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm

Tiwari,

Dash,

Chauhan

et al. 2024

J Reconstr Microsurg Open

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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.

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Section: Discussionmentioning

confidence: 96%

“…Most of the ectopic replantation was performed in two stages; in our case one additional stage was required as the neo-forearm reconstruction was done. 13 14 15…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm

Tiwari,

Dash,

Chauhan

et al. 2024

J Reconstr Microsurg Open

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“…9,10 In the case of a traumatic amputation with a segmental defect and preserved distal tissue, it may be reasonable to consider temporary ectopic replant to preserve spare parts. 11 In cases of combined vascular and orthopaedic skeletal injury, debate continues regarding the best timing and order of revascularization and skeletal stabilization. 12,13 It may be beneficial to consider initial temporary shunting before provisional fracture stabilization in certain situations to minimize ischemia time and reperfusion injury and increase distal tissue viability.…”

Section: Performing the First Debridementmentioning

confidence: 99%

Preventing biological waste: Effective use of viable tissue in traumatized lower extremities

Lansford

McCarthy

Souza

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Severe open lower extremity trauma requires debridement to remove contamination and devitalized tissues. Aggressive debridement should be balanced with preservation of viable tissue. These often damaged but preserved viable tissues are “spare parts” that augment the options available for reconstruction. The long-term goal of reconstruction should be functional limb restoration and optimization. Injury patterns, levels, and patient factors will determine whether this endeavor is better accomplished with limb salvage or amputation. This article reviews the rationale and strategies for preserving spare parts throughout debridement and then incorporating them as opportunistic grafts in the ultimate reconstruction to facilitate healing and maximize extremity function. Level of Evidence: 5.

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“…The ectopic implantation time was between 1 and 6 months. Different recipient sites were used, the most preferred ones being the forearm and lower abdomen (Tu et al 2018). The more time the segment remains in its ectopic position, the lower functional results could be obtained.…”

Section: Alternative Reconstructive Optionsmentioning

confidence: 99%

Major Amputations at the Arm and Forearm Level: Replantation Strategy and Technique

Tos¹,

Crosio²,

Giacalone³

et al. 2020

Clinical Scenarios in Reconstructive Microsurgery

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Amputations at the arm and forearm level are an emergency frequently associated with potentially fatal concomitant injuries. The loss of a big segment of the upper limb is, however, a source of high disability for the patients, so every effort to replant the severed part should be made. First of all, the patients have to be evaluated by the anesthesiologist to understand the risk of replantation. Many different characteristics concerning the mechanism of trauma, ischemia time, and

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Temporary ectopic implantation for salvaging amputated parts: A systematic review

Abstract: Systematic review, level IV.

Cited by 15 publications

References 24 publications

Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm

Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm

Preventing biological waste: Effective use of viable tissue in traumatized lower extremities

Major Amputations at the Arm and Forearm Level: Replantation Strategy and Technique

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