Secondary Ectopic Replantation: Case Report

Primary ectopic replantation permits the salvage of valuable amputated parts when the stump is not suitable for primary replantation. Hardly a dozen cases have been reported to date. A case of delayed or secondary ectopic replantation was reported.

A 30-year-old male sustained an above-elbow amputation of the left arm. The part was replanted, but developed deep wound infection. After three surgical debridements, the infection could not be controlled and replant failure was impending. The decision to reamputate the part and transfer it to the groin for ectopic revascularization was made. The brachial artery and cephalic vein were connected to the femoral artery and greater saphenous vein using a Corlett's loop. The arm was kept perfused for 9 days, while the stump was surgically debrided until clean. The arm was transferred back to the stump, redoing all repairs, and a pedicled latissimus dorsi muscle flap was used for volar coverage.

Eighteen months postoperative, the elbow had 30° to 130° of AROM, the wrist and the thumb column were secondarily fused, the grip pattern was functionally useful, and the sensation of the hand was S3.

An infected major replant will fail unless infection can be surgically controlled. If this is not the case, ectopic transfer of the valuable part, with subsequent return of this part to its position once the infection of the stump is controlled, may be a salvage procedure. To the best of the authors' knowledge, this is the first case reported, and should probably be included in the replantation armamentarium for very difficult situations.