Preliminary functional outcomes after staged heterotopic groin-pocket salvage following intraoperative thumb replantation failure: a four-patient technical case series.

Background: Intraoperative circulatory failure during thumb replantation represents a rare and challenging reconstructive scenario for which established salvage strategies and objective functional outcome data remain limited. We describe the technical feasibility and preliminary 12-month functional outcomes of a staged heterotopic groin-pocket salvage strategy in a four-patient retrospective clinical series. Methods: This retrospective technical feasibility case series included four highly selected patients with traumatic thumb amputations at the interphalangeal joint level who underwent staged heterotopic groin-pocket salvage after intraoperative replantation failure. The procedure incorporated preservation of the native flexor pollicis longus and extensor pollicis longus tendon insertion sites, delayed skeletal stabilization, staged tendon reconstruction, and adjunctive placement of a carboxymethylcellulose-hyaluronan adhesion barrier. Outcomes assessed at 12 months included interphalangeal and metacarpophalangeal joint motion, tip-to-tip pinch strength, QuickDASH score, static two-point discrimination, aesthetic satisfaction, and radiographic joint appearance. Published thumb-reconstruction outcomes were reviewed solely to provide descriptive clinical context. Results: At 12 months, mean interphalangeal flexion was 71.3°, mean metacarpophalangeal flexion was 47.5°, and mean tip-to-tip pinch strength was 4.38 kg, corresponding to 96.3% of the contralateral side. The mean QuickDASH score was 3.75, and mean static two-point discrimination was 9.5 mm. Mean aesthetic satisfaction was 2.0 on a 5-point scale, in which lower scores indicated greater satisfaction. Mild joint-space narrowing was observed radiographically at the available follow-up. No inferential statistical comparisons with published series were performed because of the small cohort size and substantial clinical and methodological heterogeneity across the literature. Conclusions: In this small, anatomically homogeneous, and highly selected series, staged heterotopic groin-pocket salvage was technically feasible and was associated with preserved thumb length and functional use at 12 months. These preliminary observations do not establish comparative effectiveness, procedural superiority, reproducibility, or long-term durability. Larger clinical series and longer follow-up are required before the technique can be considered a reproducibly effective reconstructive strategy.