Replantation of multiple digits and hand amputations: four case reports (original) (raw)
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Archives of Orthopaedic and Trauma Surgery, 2009
For the past 45 years, the advent of microsurgery has led to replantation of almost every amputated part such as distal phalanx, finger tip, etc. Replantation of digits and hand can restore not only circulation, but also function and cosmetic of the amputated part. The goals of replantation are to restore circulation and regain sufficient function and sensation of the amputated part. Strict selection criteria are necessary to optimize the functional result. The management of this type of injuries includes meticulous preoperative management, microsurgical experience and continuous postoperative care. Among various factors influencing the outcome, the most important are the type and the level of injury, ischemia time, history of diabetes, age, sex, and smoking history. During the replantation procedure, bone stabilization, tendon repair, arterial anastomoses, venous anastomoses, nerve coaptation, and skin coverage should be performed. All structures should be repaired primarily, unless a large nerve gap or a flexor tendon avulsion injury is present. Adequate postoperative evaluation is mandatory to avoid early or late complications. To improve functional results, many replantation patients may need further reconstructive surgery.
Successful Hand Replantation in a Case of Total Avulsion without Vein Graft
Plastic and reconstructive surgery. Global open, 2018
Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation-a completely amputated hand-by vascular anastomosis technique was successfully performed. Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al. in 1968. The overall success rate of limb replantation surgery is around 83.2%. The mechanism of injury plays a role in the outcome; guillotine amputations-for example-carry a better prognosis than crush amputations. We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his ha...
Oman Medical journal, 2011
An amputation of the hand is a devastating injury. It adversely affects the victim's ability to earn a livelihood, support a family, and carry out daily activities. It has a great psychological impact. We report a middle aged male with an amputation at the level of the distal forearm who underwent replantation. The operative details of this case are described. Awareness of the possibility of salvage should be spread among healthcare personnel and the need for immediate attention by a multispeciality team is advocated. This report reviews the literature related to the operative technique, contraindications and long term results.
Replantation of upper extremity, hand and digits
Acta chirurgica iugoslavica, 2013
Replantation is defined as reattachment of the part that has been completely amputated and there is no connection between the severed part and the patient. In Boston in 1962 Malt successfully replanted a completely amputated arm of a 12-yearold boy. Komatsu and Tamai reported the first successful replantation of an amputated digit by microvascular technique. There are no strict indications and contraindications for replantation. It?s on surgeon to explain to the patient the chances of success of viability, expected function, length of operation, hospitalization and long rehabilitation protocol. Survival and useful function in replantation of upper extremity amputations is questionable. Success depends on microvascular anastomoses, but the final function is related with tendon, nerve, bone and joint repair.
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
Results of Replantation of 33 Ring Avulsion Amputations
The Journal of Hand Surgery, 2013
Purpose Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injuries.
Replantation of Nine Fingers in a Patient: A case report
Sultan Qaboos University Medical Journal [SQUMJ], 2019
Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors’ knowledge, this is the first case of several finger amputations in Oman.Keywords: Fingers; Traumatic Amputation; Crush Injuries; Replantation; Case Report; Oman.
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...
Results of upper limb digital and hand replant and revascularisation at a UK Hand Centre
European Journal of Plastic Surgery, 2015
Background There is an increasing awareness of replantation amongst the general public, with an expectation for reattachment of digits. Currently, there is a paucity of evidence on the outcomes of replantation or revascularisations in the UK with most surgical experience literature from the USA or East Asian countries. Methods We report a case series of 28 patients over a 7-year period with replantation or revascularisation performed at a tertiary National Health Service hand centre in the UK. Data was collected retrospectively from hospital clinical notes and electronic imaging. Results Out of the 28 patients identified, 16 had single digit replantation or revascularisation, of which 11 digits ultimately survived. Nine patients underwent multiple digit replantation or revascularisation with a combined total of 25 digits, only five of these digits survived. Conclusions Factors found to adversely affect survival were increased number of attempted replants, power-saw mechanism of injury and prolonged ischaemic time. Reduced ischaemic times and single digit amputations were associated with improved survival. Level of Evidence: level IV, risk/prognostic study.