Brief Ectopic Banking and Immediate Plate Fixation With Free Omental Flap Addresses Multiple Fundamental Problems for Single-Stage Replant of Transhumeral Amputation

Abstract

High-velocity traumatic amputations of the proximal upper extremity are devastating to the patient and represent an extreme surgical challenge to the treatment team. The hand surgeon must simultaneously battle devascularization with timely microvascular anastomosis, gross contamination with meticulous debridement, and amputation with stable fixation. In restoring a functional extremity, many of these goals are in contention with each other. This case describes a novel management strategy for a left transhumeral amputation sustained by a 23-year-old man in a motorcycle accident. The amputated arm was temporized by ectopic banking via the lateral circumflex femoral artery to allow for thorough debridement and immediate open reduction internal plate fixation with coverage provided by a free omental flap and subsequent split-thickness skin graft. This strategy allows for a single-stage treatment of upper arm amputations with immediate microvascular anastomosis, stable internal fixation, and soft tissue coverage by the omentum providing immunogenic and lymphangiogenic properties to combat infection, lymphedema, and swelling. Functional reconstruction was then performed in a staged fashion with a free functional muscle transfer using the contralateral gracilis.