Selective replantation with ulnar translocation in multidigital amputations (original) (raw)
Related papers
Finger Replantation, Good and Bad Results
Journal of Reconstructive Microsurgery, 2014
There are different causes for finger amputation. Causes are starting from clean cut amputation up to avulsion. There are many factors affecting the results of finger replantation, as cause of injury, age of the patient, level of amputation, time passed after injury, methods for preservation of the amputated part, trained surgeons, and surgical equipments. Other factors affect the results of finger replantation are number of digital amputation, surgeon comfortability, and patient cooperation. This study included 38 patients presented by amputation of 57 fingers. The average age was 23 years old. The main cause was machine injury. The dominant hand was the right hand. The dominant finger was the thumb. The level of injury was proximal to the proximal interphalangeal joint in most of cases. The average time passed between injury and replantation was 2 hours. The average time of surgery for one digit replantation was 4 hours. The principles of treatment was exploration of the neurovascular and tendons in the amputated digit initially then that of the stump. The order of treatment was bone fixation by 2 kirschner wire, digital artery, digital vein, flexor tendon, digital nerve, extensor tendon. Skin closure should be loose. The average follow up was 58 months. All fingers have been survived except five. The average time for bone union was 8 weeks. According to Chen's criteria, the overall results were classified as grade I (excellent) in 20 cases, grade II (good) in 16 cases and grade III (fair) in 2 cases. The tendon function was excellent in 20 fingers, good in 26 fingers fair in 3 fingers, poor in 2 fingers and failure in 6 fingers. The 2 point discrimination was 6 mm in 9 fingers, 7-10 mm in 29 fingers, and 12-15 mm in 13 fingers. The mean grip and pinch strengths were 80 % and 85% respectively compared to contralateral hand. All of patient had returned to their normal daily activities. Finally, finger replantation is not an easy job and it is considered as challenging procedure even for the specialist. I think that many factors affecting the results of finger replantation have not been discovered yet.
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.
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.
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.
Finger Replantation in Sanglah General Hospital: Report of Five Cases and Literature Review
Bali Medical Journal, 2016
Background: Replantation is the prime treatment for amputated hands and fingers due to functional and aesthetic advantages. The absolute indications for replantation are amputations of the thumb, multiple fingers, trans metacarpal or hand, and any upper extremity in a child, regardless of the amputation level. A fingertip amputation distal to the insertion of the flexor digitorum superficialis (FDS) is also a good indication. Indications have been expanded to include amputation at nail level, and when there is a request from the patient, replantation is attempted even for a single finger amputation regardless of the amputation level. Based on the mechanism of injury, a clean-cut sharp amputation is more likely replanted compare to a crush and avulsion injuries. With a proper management of the amputated finger, replantation can be attempted even after 24 hours. This report was written to provide examples of finger replantation cases and the measures that can be taken in a resource-limited hospital in order to conduct a replantation. Case Series: We reported five out of nine digital replantation cases in Sanglah General Hospital between January and July 2014. Two patients were a six and an eleven years old boys who accidentally cut their finger while playing, the rests were male labors between 20-30 years old whose amputations due to machine injuries. Result: A 100% replant survival was achieved. After a period of follow up with occupational therapy, all patients regain good functional and cosmetic results.
A Unique Case of Replantation of Previously Replanted Fingers
Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, 2021
Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be atte...
Reconstructive surgery of the amputated ring finger
International Orthopaedics, 2017
Purpose Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. Materials and methods In this retrospective study, nine consecutive patients who sustained mutilating ring finger injury were managed by fourth ray amputation with fifth ray transposition between January 2008 and December 2014. There were six males and three females with a mean age of 30.2 ± 12.2 years (age range, 16-56 years) at the time of surgery who underwent delayed fourth ray amputation with fifth ray transposition (after 14 days of injury). Eight cases had undergone previous surgical interventions: three ORIF using intramedullary K-wire fixation, one failed reimplantation, four debridement and application of split thickness skin graft. Primary skin closure of the amputated finger was not considered as previous surgery (one patient). Results All patients were followed up for a mean period of 17.1 ± 4.1 months (range, 12-24 months). Grip strength and RAS score improved after fourth ray resection. The postoperative grip strength and RAS (score) were not compromised by the associated hand dominance. Conclusion The following conclusions can be made despite the fact that this was a limited study as well as a retrospective analysis: 1-In technical terms, resection of the fourth ray with transposition of the small finger with a wedge-shaped hamatecapitate arthrodesis secured by screw fixation is easier than metacarpal osteotomy/transposition and less liable to postoperative complications. 2-The results of this study suggest that fourth ray resection and transposition of the small finger with a hamate-capitate arthrodesis restores hand function and cosmetics.
The Journal of Hand Surgery, 2007
Fingertip replantation is now an established technique. Although successful replantation is an ideal method for treatment of fingertip amputation, various other methods still are widely used and may be functionally acceptable. The indications for replantation to treat fingertip amputation is still controversial. This article presents a global view of the current status of replantation for the treatment of fingertip amputation. The surgical technique, strategies to overcome postoperative congestion, and overall results are discussed.
The Journal of Hand Surgery, 2006
To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Methods: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Results: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Conclusions: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. (J Hand Surg 2006;31A:811-818.