Temporary ectopic banking as a treatment option for mangled thumb: a case report
Abstract Background Management of the extensive soft tissue injuries remains a significant challenge in orthopedic and plastic reconstructive surgery. Since the thumb is responsible for 40% of the functions of the hand, saving and reconstructing a mangled thumb is essential for the patient’s future....
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BMC
2025-01-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-025-05058-9 |
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| author | Meisam Jafari Kafiabadi Adel Ebrahimpour Seyyed Hamidreza Ayatizadeh Reza Fereidooni Amirhossein Kamalinia Mehrdad Sadighi Farsad Biglari Seyed Arman Moein |
| author_facet | Meisam Jafari Kafiabadi Adel Ebrahimpour Seyyed Hamidreza Ayatizadeh Reza Fereidooni Amirhossein Kamalinia Mehrdad Sadighi Farsad Biglari Seyed Arman Moein |
| author_sort | Meisam Jafari Kafiabadi |
| collection | DOAJ |
| description | Abstract Background Management of the extensive soft tissue injuries remains a significant challenge in orthopedic and plastic reconstructive surgery. Since the thumb is responsible for 40% of the functions of the hand, saving and reconstructing a mangled thumb is essential for the patient’s future. Case presentation This case report describes the management of a severe occupational thumb injury in a 25-year-old white Persian male who sustained an occupational injury to his left thumb, resulting in extensive burn, crush injury to the distal and proximal phalanx, and severe soft tissue damage to the first metacarpal, thenar, and palmar areas. Necrosis necessitated amputation through the first metacarpophalangeal joint. Postdebridement observation revealed a viable first metacarpal bone but was exposed due to a lack of soft tissue. Given the wound contamination and infection risk, the first metacarpal bone was banked in the distal forearm. After a 4 week period of antibiotics, irrigation, debridement, and vacuum dressing, the thumb and soft tissue reconstruction were performed, retrieving the viable first metacarpal. The first metacarpophalangeal joint fusion was achieved with an intramedullary screw and two K-wires. A reverse adipofascial radial artery forearm flap and skin grafts from the left thigh were used for soft tissue reconstruction. Conclusion This case highlights the importance of a flexible, staged approach to hand trauma, emphasizing the utility of ectopic banking and reconstructive techniques in managing complex hand injuries. This report contributes to the ongoing dialogue on optimal strategies for hand reconstruction, particularly in cases where traditional immediate reconstruction is not feasible. |
| format | Article |
| id | doaj-art-bb296a2701134d468438402f1606ab4d |
| institution | Kabale University |
| issn | 1752-1947 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj-art-bb296a2701134d468438402f1606ab4d2025-01-26T12:35:32ZengBMCJournal of Medical Case Reports1752-19472025-01-011911610.1186/s13256-025-05058-9Temporary ectopic banking as a treatment option for mangled thumb: a case reportMeisam Jafari Kafiabadi0Adel Ebrahimpour1Seyyed Hamidreza Ayatizadeh2Reza Fereidooni3Amirhossein Kamalinia4Mehrdad Sadighi5Farsad Biglari6Seyed Arman Moein7Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical SciencesDepartment of Orthopedic Surgery, Clinical Research Development Unit of Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical SciencesTrauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical SciencesHealth Policy Research Center, Institute of Health, Shiraz University of Medical SciencesBone and Joint Diseases Research Center, Shiraz University of Medical SciencesDepartment of Orthopedic Surgery, Clinical Research Development Unit of Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical SciencesDepartment of Orthopedic Surgery, Clinical Research Development Unit of Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical SciencesBone and Joint Diseases Research Center, Shiraz University of Medical SciencesAbstract Background Management of the extensive soft tissue injuries remains a significant challenge in orthopedic and plastic reconstructive surgery. Since the thumb is responsible for 40% of the functions of the hand, saving and reconstructing a mangled thumb is essential for the patient’s future. Case presentation This case report describes the management of a severe occupational thumb injury in a 25-year-old white Persian male who sustained an occupational injury to his left thumb, resulting in extensive burn, crush injury to the distal and proximal phalanx, and severe soft tissue damage to the first metacarpal, thenar, and palmar areas. Necrosis necessitated amputation through the first metacarpophalangeal joint. Postdebridement observation revealed a viable first metacarpal bone but was exposed due to a lack of soft tissue. Given the wound contamination and infection risk, the first metacarpal bone was banked in the distal forearm. After a 4 week period of antibiotics, irrigation, debridement, and vacuum dressing, the thumb and soft tissue reconstruction were performed, retrieving the viable first metacarpal. The first metacarpophalangeal joint fusion was achieved with an intramedullary screw and two K-wires. A reverse adipofascial radial artery forearm flap and skin grafts from the left thigh were used for soft tissue reconstruction. Conclusion This case highlights the importance of a flexible, staged approach to hand trauma, emphasizing the utility of ectopic banking and reconstructive techniques in managing complex hand injuries. This report contributes to the ongoing dialogue on optimal strategies for hand reconstruction, particularly in cases where traditional immediate reconstruction is not feasible.https://doi.org/10.1186/s13256-025-05058-9Mangled thumbEctopic bankingSoft tissue reconstructionReverse radial artery forearm flap |
| spellingShingle | Meisam Jafari Kafiabadi Adel Ebrahimpour Seyyed Hamidreza Ayatizadeh Reza Fereidooni Amirhossein Kamalinia Mehrdad Sadighi Farsad Biglari Seyed Arman Moein Temporary ectopic banking as a treatment option for mangled thumb: a case report Journal of Medical Case Reports Mangled thumb Ectopic banking Soft tissue reconstruction Reverse radial artery forearm flap |
| title | Temporary ectopic banking as a treatment option for mangled thumb: a case report |
| title_full | Temporary ectopic banking as a treatment option for mangled thumb: a case report |
| title_fullStr | Temporary ectopic banking as a treatment option for mangled thumb: a case report |
| title_full_unstemmed | Temporary ectopic banking as a treatment option for mangled thumb: a case report |
| title_short | Temporary ectopic banking as a treatment option for mangled thumb: a case report |
| title_sort | temporary ectopic banking as a treatment option for mangled thumb a case report |
| topic | Mangled thumb Ectopic banking Soft tissue reconstruction Reverse radial artery forearm flap |
| url | https://doi.org/10.1186/s13256-025-05058-9 |
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