Advertisement

Secondary Thumb Reconstruction via Ectopic Banking of Bony Phalanges From a Nonreplantable Amputated Thumb: A Follow-Up Study

  • Kai Yang
    Affiliations
    School of Clinical Medicine, Tsinghua University, Beijing, China

    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
  • Jiuzheng Deng
    Affiliations
    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
  • Yongwei Pan
    Correspondence
    Corresponding author: Yongwei Pan, MD, PhD, Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
    Affiliations
    School of Clinical Medicine, Tsinghua University, Beijing, China

    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
  • Ye Yuan
    Affiliations
    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
  • Guman Duan
    Affiliations
    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
  • Jianjin Zhu
    Affiliations
    Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
    Search for articles by this author
Published:August 26, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.06.027

      Purpose

      This study aimed to evaluate the radiological and functional results of secondary thumb reconstruction via ectopic banking of bony phalanges from a nonreplantable amputated thumb.

      Methods

      Thumb reconstruction was performed using the bony phalanges from a nonreplantable amputated thumb that were ectopically banked in a subcutaneous pocket. A wraparound flap was harvested from the ipsilateral great toe and wrapped around the bone graft. After surgery, the results were assessed in terms of infection, range of motion, bone union of the graft, and signs of osseous resorption of the reconstructed thumb.

      Results

      Fifteen patients underwent secondary thumb reconstruction using this technique between January 2003 and October 2018. Ten patients were followed up for at least 6 months (6 months to 9 years) and were included in this study. All wraparound flap transfers were viable. No bone graft infection was observed. In the 6 cases in whom the interphalangeal joint was not fused, the interphalangeal joint motion ranged from 5° to 60° with an average of 35.0° ± 15.1°. The metacarpophalangeal joint motion ranged from 5° to 66°, with an average range of motion of 48.2° ± 23.6° for the cases in whom the joint was not fused. In 8 of the 10 patients, the time of bone ectopic banking was within 10 days. In these patients, bone union with no osseous atrophy was observed. In 2 patients whose phalanx was banked for more than a month, different degrees of bone resorption of the grafted phalanx were evident after transplantation, although no further treatment was required.

      Conclusions

      Bony phalanges from a nonreplantable amputated thumb can be ectopically banked and used for secondary reconstruction of the thumb. The duration of banking before thumb reconstruction should be no more than 2 weeks.

      Type of study/level of evidence

      Therapeutic V.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ward W.A.
        • Tsai T.M.
        • Breidenbach W.
        Per primam thumb replantation for all patients with traumatic amputations.
        Clin Orthop Relat Res. 1991; 266: 90-95
        • Heitmann C.
        • Levin L.S.
        Alternatives to thumb replantation.
        Plast Reconstr Surg. 2002; 110 (quiz 1504): 1492-1503
        • Ray E.C.
        • Sherman R.
        • Stevanovic M.
        Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr.
        Surg. 2009; 123: 259-267
        • Graham D.J.
        • Venkatramani H.
        • Sabapathy S.R.
        Current reconstruction options for traumatic thumb loss.
        J Hand Surg Am. 2016; 41: 1159-1169
        • Gillies H.D.
        Autograft of amputated digit. A suggested operation.
        Lancet. 1940; 1: 1002-1004
        • Gillies H.
        • Reid D.A.
        Autograft of the amputated digit.
        Br J Plast Surg. 1955; 7: 338-342
        • Domanasiewicz A.
        • Jabłecki J.
        Transplantation of amputated bony phalanges as a salvage thumb reconstruction method – a preliminary report.
        Ortop Traumatol Rehabil. 2009; 11: 549-561
        • Salah M.M.
        • Khalid K.N.
        Thumb reconstruction by grafting skeletonized amputated phalanges and soft tissue cover – a new technique: a case series.
        Cases J. 2008; 1: 22
        • Xu J.
        • Wen G.
        • Chai Y.
        Thumb reconstruction with combination of the wrap-around flap prefabricated by medialis pedis perforator flap with nail bed and phalanx banked from the amputated thumb: a case report.
        Microsurgery. 2020; 40: 59-64
        • Tsai T.M.
        • Falconer D.
        Modified great toe wrap for thumb reconstruction.
        Microsurgery. 1986; 7: 193-198
        • Pan Y.W.
        • Zhang L.
        • Tian W.
        • Tian G.
        • Zhao J.
        • Guo X.
        Donor foot morbidity following modified wraparound flap for thumb reconstruction: a follow-up of 69 cases.
        J Hand Surg Am. 2011; 36: 493-501
        • Pet M.A.
        • Ko J.H.
        • Vedder N.B.
        Reconstruction of the traumatized thumb.
        Plast Reconstr Surg. 2014; 134: 1235-1245
        • Steichen J.B.
        • Weiss A.P.
        Reconstruction of traumatic absence of the thumb by microvascular free tissue transfer from the foot.
        Hand Clin. 1992; 8: 17-32
        • Waljee J.F.
        • Chung K.C.
        Toe-to-hand transfer: evolving indications and relevant outcomes.
        J Hand Surg Am. 2013; 38: 1431-1434
        • Ebraheim N.A.
        • Elgafy H.
        • Xu R.
        Bone-graft harvesting from iliac and fibular donor sites: techniques and complications.
        J Am Acad Orthop Surg. 2001; 9: 210-218
        • Henry S.L.
        • Wei F.C.
        Thumb reconstruction with toe transfer.
        J Hand Microsurg. 2010; 2: 72-78
        • Friedrich J.B.
        • Poppler L.H.
        • Mack C.D.
        • Rivara F.P.
        • Levin L.S.
        • Klein M.B.
        Epidemiology of upper extremity replantation surgery in the United States.
        J Hand Surg Am. 2011; 36: 1835-1840
        • Pomares G.
        • Coudane H.
        • Dap F.
        • Dautel G.
        Epidemiology of traumatic upper limb amputations.
        Orthop Traumatol Surg Res. 2018; 104: 273-276
        • Kawabata H.
        • Tamura D.
        Five- and 10-year follow-up of nonvascularized toe phalanx transfers.
        J Hand Surg Am. 2018; 43: 485.e1-485.e5
        • Sabapathy S.R.
        • Mohan M.
        • Shanmugakrishnan R.R.
        Nonvascularized free toe phalangeal transfers in congenital hand differences: radiological, functional, and patient/parent-reported outcomes.
        J Hand Surg Am. 2021; 46: 1124.e1-1124.e9
        • Jaloux C.
        • Guéro S.
        • Hoang L.V.
        Non-vascularized toe phalanx transfer for digital reconstruction in adults: a report of two cases.
        J Hand Surg Eur Vol. 2021; 46: 1006-1008
        • Aguirre J.I.
        • Plotkin L.I.
        • Stewart S.A.
        • et al.
        Osteocyte apoptosis is induced by weightlessness in mice and precedes osteoclast recruitment and bone loss.
        J Bone Miner Res. 2006; 21: 605-615
        • Rolvien T.
        • Amling M.
        Disuse osteoporosis: clinical and mechanistic insights.
        Calcif Tissue Int. 2022; 110: 592-604