Staged Thumb Reconstruction Via Primary Ectopic Banking of Detached Skeletal Elements and Amputated Thumbs With Secondary Replantation.

BACKGROUND: Extensive injuries involving the thenar region and traumatic thumb amputation, with or without involvement of additional digits, present complex reconstructive challenges. In cases where the severed thumb remains anatomically intact, immediate replantation or ectopic replantation using another digit may not be feasible. Following debridement and closure of the thenar region, the absence of the thumb can significantly compromise hand function. Reconstruction using the autologous intact severed thumb, along with detached metacarpal and phalangeal bones preserved within healthy tissue, may represent a promising surgical approach.

CASE DESCRIPTION: Nine patients with severe hand injuries underwent primary ectopic banking procedures between February 2005 and December 2022. Severed thumbs deemed unsuitable for immediate replantation were revascularized through vascular anastomosis and preserved at alternative anatomical sites. Detached metacarpal and phalangeal bones were embedded subcutaneously in healthy tissue following debridement. After a period of 1 to 4 months, the banked thumbs and preserved skeletal elements were combined and replanted to reconstruct the thumb. All reconstructed thumbs demonstrated postoperative survival. Functional outcomes were assessed as excellent in 5 cases, good in 3 cases, and fair in 1 case.

CONCLUSIONS: Staged thumb reconstruction using primary ectopic banking of detached metacarpal or phalangeal bones along with severed thumbs, followed by secondary combined replantation, represents a feasible surgical technique yielding favorable functional outcomes.