Replantation of an Amputated Hand: A Rare Case Report and Acknowledgement of a Multidisciplinary Team Input (original) (raw)
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Replantation of an Amputated Hand- A Landmark surgery with Multidisciplinary Team Approach
Cardiovascular Journal
An amputation of the hand is a disastrous traumatic injury especially for advanced machinery workers which adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities. It also produces great psychological impact. In the following case report, we described a middleaged male with an amputation at the level of the distal forearm who underwent replantation. The transfer of the amputated hand, operative technique and postoperative status are described. Awareness of the possibility of salvage should be spread among healthcare providers and the need for immediate attention by a multispecialty team is advocated. This report reviews the literature related to the operative technique, contraindications and long-term results. Cardiovasc j 2022; 15(1): 106-110
Initial experience with hand replantation after traumatic amputation in a nonspecialized center
Jornal Vascular Brasileiro, 2006
Traumatic amputation of the hand is an incapacitating injury, requiring skilled surgical care. Achieving functional recovery in addition to salvage of the amputated extremity should be the goal of the patient care team, after the life of the patient is secured. This is a report of the first five cases of hand replantation after complete traumatic amputation in Manaus (Amazonas, Brazil), carried out at Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado. The patients were all young males, mean age of 22.8 years, presenting at the emergency room with complete sharp amputation of the hand. After initial procedures according to the ATLS® protocol, the following surgical actions were taken: heparinization of the blood vessels of the amputated extremity, fixation of the bones, wide opening of the carpal tunnel, primary vascular anastomoses and repair of nerves and tendons. In four cases, viability and partial functional recovery of the replanted hands were achieved. The unsuccessful ca...
Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience
Indian Journal of Plastic Surgery, 2013
Background: Replantation is defined as reattachment of amputated limb using neurovascular and musculoskeletal structures in order to obtain recovery of limb. Re-vascularisation involves all the above steps in case of limb injuries that result in a near total amputation. Aim and Objective: To study the functional outcome of patients undergoing replantation of hand at wrist level. Material and Methods: This is a retrospective study of patients who underwent replantation of total amputation of hand at wrist level within a period of Jan 2003-June 2010. We evaluated post operative functional outcome compared to uninjured hand taking into consideration: 1. The patient′s overall satisfaction with the hand. 2. Recovery of flexor and extensor function of thumb and fingers. 3. Recovery of thumb opposition. 4. Recovery of sensations in the median and ulnar nerve distribution. 5. Ability of surviving hand to perform daily tasks. Results: There were total seventeen patients and age range was two...
Successful Replantation of an Amputated Thumb : A Case Report
Orthopedics and Rheumatology Open Access Journal, 2017
The best indication of replantation is first of all, the amputated thumb, among all fingers, since the thumb is functionally the most important digit. Therefore, replantation of the thumb should be attempted even under unfavorable conditions. We report a replantation surgery in a young male patient with an amputation of the thumb between the base of proximal phalanx and the interphalangeal joint.
Critical analysis of upper limb replantations
2006
Objective: The authors analyze the follow-up of results in 62 adult patients who had traumatic amputations in the upper limb and who underwent successful replantation procedures from 1994 to 2004. Methods: The levels of amputation were in fingers or thumb in 48, hand in 5, wrist in 4, forearm in 2 and arm in 3 patients. All patients were treated in a rehabilitation program of specialized hand therapy. A simplified questionnaire was used to evaluate the return to work activities using the operated limb, either in the formal or informal economy, and the patient’s satisfaction rate concerning the surgical procedure. Results: It was noted that 85.5% of patients returned to some work activity using the operated limb and 96.8% of patients are satisfied with the results. Conclusions: Patients submitted to successful replantation present a high rate of satisfaction and return to work activities.
Replantation in the mutilated hand
Hand Clinics, 2003
With the evolution of surgical techniques and scientific technology, replantation has become more refined, establishing specific indications for replantation, rituals for preparation, efficient techniques to ultimately minimize ischemia times, improved survival rates, guidelines for postoperative care, strategies for treating complications, and goals for outcomes. Patient satisfaction hinges on their level of expectation as defined and explained in the preoperative discussion and informed consent. Studies have demonstrated patients can be expected to achieve 50% function and 50% sensation of the replanted part. Initially all that was amputated was replanted, as surgeons adopted the philosophy of George C. Ross (1843-1892): "Any fool can cut off an arm or leg but it takes a surgeon to save one." Forty years after the first replant (1962-2002), however, we recognize the ultimate goal: not merely to preserve all living tissue through nonselective replantation, but rather to preserve one's quality of life by improving their function and appearance. This objective to care for the patient with the intent to optimize function and appearance is important not only to the replantation of amputations but to all mutilated hand injuries.
Functional Salvage of a Hand After Unsuccessfull Attempt of Replantation
Clujul Medical, 2016
Amputation by crush injuries generally represents a contraindication for replantation, and especially when the lesion is caused by the summation of multiple concomitant traumatic mechanisms.We present the case of a 22 year- old female who arrived in our service with a crush/torsion amputation of all long fingers at the metacarpo-phalangeal level of the right hand. After the unsuccessful attempt of replantation, the functional reconstruction of the hand was achieved by using a double free flap transfer: anterolateral thigh perforator flap (ALT) and digital block transfer of second and third toes.
Replantation of multiple digits and hand amputations: four case reports
Cases Journal, 2008
This study reports four cases of hand avulsion at the proximal wrist level and multiple digits amputation were received in plastic and hand surgery unit during the year 2007-2008. All patients were male labors between 22-30 years old, and the amputation due to machine injuries. Successful replantation were achieved, after a period of follow up with occupational therapy all patients regain good functional and cosmetic results. This study proves the strong indication of replantation of multiple digits & hand amputations.
Since the first successful salvage of an amputated finger using microsurgical anastomoses in 1965, replan-tation has been widely used in these decades and is now firmly established as a viable treatment option in traumatic limb amputation. The current concepts of replantation surgery for upper limb amputation are discussed in this review article in terms of history of replantation, present indications for the procedure, pre-theater care, technical refinements, postoperative management and functional outcome. In this article , we demonstrated that the advent of microsurgery has led to replantation of almost every amputated part of the upper limb possible. Replantation of digits and the hand can restore not only circulation but also function and cosmetic appearance. However, major amputations remain a challenge and the functional outcome is often disappointing, albeit the success rate of replantation exceeds 80%. Proper patient selection, adequate pre-theater preservation, good operative skill and postoperative care, as well as tight cooperation among the patient, the surgeon, and the rehabilitation therapist will help to achieve a better final functional outcome.