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

Kai Yang; Jiuzheng Deng; Yongwei Pan; Ye Yuan; Guman Duan; Jianjin Zhu

doi:10.1016/j.jhsa.2022.06.027

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

J Hand Surg Am. 2022 Aug 26:S0363-5023(22)00393-8. doi: 10.1016/j.jhsa.2022.06.027. Online ahead of print.

Authors

Kai Yang¹, Jiuzheng Deng², Yongwei Pan³, Ye Yuan², Guman Duan², Jianjin Zhu²

Affiliations

¹ School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
² Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³ School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. Electronic address: ywpan2013@163.com.

PMID: 36038426
DOI: 10.1016/j.jhsa.2022.06.027

Abstract

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.

Keywords: Amputated bone; bone resorption; ectopic banking; thumb reconstruction; wraparound flap.