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Ectopic single-finger transplantation, a novel technique for nonreplantable digits: assessment of 24 cases--presenting the "piggyback" method.

Twenty-four cases of ectopic single-finger transplantation are reported using our new "piggyback" technique for finger transfer that simplifies, with a high success rate, the hazardous second-stage transfer. Twenty-four patients (mean age, 20 years) were treated for severely crushed proximal stumps with a replantable distal part (zones 1 and 2a). In this method, after a successful ectopic transplantation, the transplanted part is transferred to the original site not as a free tissue transfer but as a pedicle flap in which the transplanted finger is piggybacked to the groin flap and then the composite tissue (groin and finger) is transferred to the stump. After a waiting period of 3 to 4 weeks, the flap is severed sequentially or in 1 setting. Graft take, complications, sensitivity, patient satisfaction, and demographic data of the patients were evaluated.Graft take was 75% in the first stage and 100% in the second stage. There were no cases of infection, and minor complications such as edema subsided with time. Distal finger amputations have the best indication for replantation. A Pearson Educational Measurement score was obtained from the patients who participated in 6-month and 1-year follow-ups, and at the end of 1 year, 85% of the patients scored above 45 points. Eighty-seven percent of the patients were satisfied with their results and stated they would choose this procedure again if indicated and also would recommend it to other patients.The piggyback method of transfer of the ectopic single-finger transplantation has simplified the arduous and risky second-stage transfer to a low-risk and highly successful operation. The advantages include a less bulky tissue transfer, no severed major artery, and 2 short surgical procedures replacing 1 lengthy, potentially risky free vascularized procedure. The only drawback of this technique is the 3-week waiting period for the pedicle flap, wherein the hand is attached to the groin. The reconstruction of the nerve, artery, and tendon and, sometimes, when it is not possible to accomplish proper bone fixation at the second stage, can be achieved with ease after severing the pedicle.

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