Heterotopic digital replantation for restoring hand function
DOI:
https://doi.org/10.18203/2349-2902.isj20253736Keywords:
Heterotopic digital replantation, Thumb reconstruction, Finger transplant, Microsurgery, Hand trauma, Functional restorationAbstract
Heterotopic digital replantation is a specialized reconstructive microsurgical technique used when an amputated digit cannot be replanted to its original site due to extensive local damage or multiple amputations. Instead, the viable digit is transferred to a non-anatomic position-most often to reconstruct the thumb or restore opposition-aiming to maximize functional outcome rather than anatomic accuracy. This approach is particularly indicated in cases of irreparable thumb loss, multiple non-replantable digits, or severe joint destruction where restoring prehension is the primary goal. The procedure requires precise microsurgical anastomosis of vessels and nerves and may be combined with free tissue or joint transfers. Reported outcomes show satisfactory sensory recovery, range of motion, and grip strength when careful surgical planning and rehabilitation are applied. However, potential complications include vascular thrombosis, infection, wound healing disorders, and long-term stiffness or sensory deficits. Despite these challenges, heterotopic replantation remains a valuable option for restoring meaningful hand function in complex injuries where traditional replantation is not feasible.
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References
Ma Z, Zhang X, Wang G, Lei Z, Yantao P, Yuliang S, et al. Long-term follow-up of thumb reconstruction with a heterotopic replanted finger: Case report and literature review. Front Bioeng Biotechnol. 2024;12:1465108. DOI: https://doi.org/10.3389/fbioe.2024.1465108
Webb JB. Replantation in trauma. Trauma. 2005;7(1):1-9. DOI: https://doi.org/10.1191/1460408605ta325oa
Kokkoli E, Spyropoulou GA, Shih HS, Feng GM, Jeng SF. Heterotopic procedures in mutilating hand injuries: A synopsis of essential reconstructive tools. Plastic Reconstruct Surg. 2015;136(5):1015-26. DOI: https://doi.org/10.1097/PRS.0000000000001721
An PC, Kuo YR, Lin TS, Yeh MC, Jeng SF. Heterotopic replantation in mutilating hand injury. Ann Plast Surg. 2003;50(2):113-8. DOI: https://doi.org/10.1097/01.SAP.0000037269.62980.69
Reissis D, Nikkhah D, Bayne D. Safer and precise replant osteosynthesis with the T-Ring digital tourniquet. J Reconstruct Microsur Open. 2016;1(01):71-2. DOI: https://doi.org/10.1055/s-0036-1584221
Tosti R, Treiser MD, Eberlin KR. Contralateral heterotopic thumb-to-thumb replantation with free ulnar forearm fasciocutaneous flap and targeted muscle reinnervation. J Hand Surg. 2020;45(1):71.e1-5. DOI: https://doi.org/10.1016/j.jhsa.2019.03.004
Chang NJ, Chang JT, Hsu CC, Cheng-Hung L, Chih-Hung L, Yu-Te L. Heterotopic vascularized joint transfer in mutilating hand injuries. Ann Plastic Surg. 2016;76(1):S1-7. DOI: https://doi.org/10.1097/SAP.0000000000000712
Merle M, Dautel G. Advances in digital replantation. Clin Plast Surg. 1997;24(1):87-105. DOI: https://doi.org/10.1016/S0094-1298(20)32585-2
Fijany AJ, Chaker SC, Egozi HP, Hung YC, Hill BJ, Bhandari L, et al. Amputated digit replantations: critical digit ischemia timing, temperature, and other predictors of survival. Ann Plastic Surg. 2024;92(6):667-76. DOI: https://doi.org/10.1097/SAP.0000000000003944
Meyers A, Bassiri Gharb B, Rampazzo A. A systematic review of vascularized and nonvascularized toe transfer for reconstruction of congenital hand differences. Plastic Reconstruct Surg. 2023;151(6):1256-73. DOI: https://doi.org/10.1097/PRS.0000000000010116
Park LJ, Borges FK, Ofori S, Rahima N, Michael J, Heels-Ansdell D, et al. Association between complications and death within 30 days after general surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) substudy. Ann Surg. 2024;NA. DOI: https://doi.org/10.1097/SLA.0000000000006372
Lui GK, Saidi A, Bhatt AB, Luke JB, Jason FD, Michael GE, et al. Diagnosis and management of noncardiac complications in adults with congenital heart disease: A scientific statement from the American Heart Association. Circulation. 2017;136(20):e348-92. DOI: https://doi.org/10.1161/CIR.0000000000000535
Thiele RH, Theodore DJ, Gan TJ. Outcome of organ dysfunction in the perioperative period. Anesthesia and Analgesia. 2021;133(2):393-405. DOI: https://doi.org/10.1213/ANE.0000000000005603
Agusti A, Celli BR, Criner G, David H, Antonio A, Peter B, et al. Global strategy for prevention, diagnosis and management of COPD: 2025 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD), Executive Summary. Eur Respir J. 2025;61(4):2300239. DOI: https://doi.org/10.1183/13993003.00239-2023
