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Temporary ectopic banking as a treatment option for mangled thumb: a case report.
Meisam Jafari Kafiabadi1, Adel Ebrahimpour1, Seyyed Hamidreza Ayatizadeh2
1Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Journal of Medical Case Reports
|January 25, 2025
Summary
Saving a mangled thumb requires advanced reconstructive surgery. This case shows ectopic bone banking and staged reconstruction effectively restored function after severe occupational thumb injury.
Area of Science:
- Orthopedic Surgery
- Plastic Reconstructive Surgery
- Hand Trauma Management
Background:
- Extensive soft tissue injuries present significant challenges in reconstructive surgery.
- The thumb's crucial role in hand function (40%) necessitates its preservation and reconstruction.
- Severe occupational thumb injuries pose complex management dilemmas.
Purpose of the Study:
- To describe the management of a severe occupational thumb injury.
- To highlight reconstructive techniques for complex hand trauma.
- To emphasize a flexible, staged approach to hand reconstruction.
Main Methods:
- Case report of a 25-year-old male with a severe occupational thumb injury involving burn, crush, and soft tissue damage.
- Amputation through the first metacarpophalangeal joint followed by ectopic banking of the first metacarpal in the distal forearm.
- Staged reconstruction utilizing the banked metacarpal, intramedullary fixation, a reverse adipofascial radial artery forearm flap, and skin grafts.
Main Results:
- Successful reconstruction of the mangled thumb and soft tissue.
- Achieved first metacarpophalangeal joint fusion with intramedullary fixation.
- Demonstrated the viability of ectopic bone banking for complex hand injuries.
Conclusions:
- A flexible, staged approach is vital for managing complex hand trauma.
- Ectopic bone banking and advanced reconstructive techniques are effective when immediate reconstruction is not feasible.
- This case contributes to optimal strategies for severe hand reconstruction.
