Case report and literature review of the outcome following reimplantation of the arm (original) (raw)
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Oman medical journal, 2009
Severe crush injuries to the upper limb may require a formal amputation with devastating consequences to the patient. We report a patient with a near total amputation at the level of mid-forearm who underwent revascularization and salvage of his hand. The operative details of this case are described. It is the first time that such a patient has been treated successfully by plastic surgeons and orthopedic surgeons at the Sultan Qaboos Hospital, Salalah. Awareness of the possibility of salvage should be spread among health care personnel as well as the need for immediate attention by a multispeciality team. Literature related to the operative technique, contraindications and long term results is reviewed.
Traumatic and trauma-related amputations: Part II: Upper extremity and future directions
The Journal of bone and joint surgery. American volume, 2010
Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.
Lower limb amputation in trauma sequelae: choice of level and techniques
Lo Scalpello - Otodi Educational
The main purpose of amputation is to bring a specific patient, regardless of the initial scenario, to a new normality, characterized by the absence of pain and functional potential of the stump in terms of wearability and power. It is therefore implicit that the strategy is played on the choice of the level, using both analysis of the scenario of the patient and the perspective of the prosthetic project. Hence the delicacy of the choice of the moment and the level of amputation, considering multiple possibilities arising from evolution of surgical techniques, interdigitation of skills between traumatologist and plastic surgeon, translation of some techniques initially used for amputations of the upper limb to amputations of the lower limb, to substantial innovations in limb prostheses.
Critical analysis of upper limb replantations Análise crítica dos reimplantes no membro superior
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.
Management of Upper Limb Amputations
The Journal of Hand Surgery, 2011
Acquired upper extremity amputations beyond the finger can have substantial physical, psychological, social, and economic consequences for the patient. The hand surgeon is one of a team of specialists in the care of these patients, but the surgeon plays a critical role in the surgical management of these wounds. The execution of a successful amputation at each level of the limb allows maximum use of the residual extremity, with or without a prosthesis, and minimizes the known complications of these injuries. This article reviews current surgical options in performing and managing upper extremity amputations proximal to the
Severe complex injuries to the upper extremity: Revascularization and replantation
The Journal of Hand Surgery, 1991
Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result. Bone shortening osteotomies are a helpful way to reduce the soft tissue defect size. In contrast to earlier studies, clear correlations between the level of injury, degree of nerve lesion, bone pathology, and the number of major nerves involved, and the functional outcome achieved were not found. There was a weak correlation between the type of wound and the functional recovery ultimately obtained. (J HAND SURC 1991;16A:574-84.)
Limb Salvage Versus Amputation: A Review of the Current Evidence
Cureus, 2020
In the trauma situation where the trauma team is faced with a severely injured limb, it requires judicious thinking and evaluating not only the injury in isolation but the patient as a whole when considering the management options. The aim must be to give the best quality of life and avoid repeated admissions to hospital for associated complications in the future. The decision to amputate or salvage a limb should be based on numerous factors, such as the patient's pre-injury status, injury factors (soft tissue injury, location, contamination and physiological status), patient's wish and available resources. The biggest challenge when faced with a complex limb injury is deciding what management route to take with a satisfactory outcome for the patient being the main goal. Many studies have been undertaken looking at the outcome of successful limb salvage versus primary amputation. Studies such as the Learning Early About Peanut Allergy (LEAP) study have concluded that there was no difference of outcome at the two-year stage between the two strategies.
The lower limb amputation to a child following a road traffic accident
Rheumatology and orthopedic medicine, 2021
The traumatic phenomena in the lower extremities can lead to the amputations in more than 20% of the patients, especially when it is associated with the significant soft tissue loss or the severe wound contamination the blast events will require the amputation in 93% of cases. Case presentation: We present the case of a female patient, 8-year and 7-month-old who was brought by the rescue crew members to the emergency room of the Children's Clinical Hospital "Sf. Ioan", Galati, on 12.12.2020. The patient arrived at the emergency care center as a victim of a road accident, as a passenger. Intraoperatively (12.12.2020-13H.45): a complete section of the popliteal vascular-nerve bundle is revealed, which is why it is decided to amputate the lower limb segment from the proximal 1/3 of the calf. The fixation of the supracondylar fracture focus was performed with the 3 pins, achieving the bone stabilization. Conclusion: The particularity of this case consists of the difficulty to explain to a child that an adult's carelessness changed the course of her life and of the difficulty to support her morally to accept this situation.
Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and better functionality. There is also decrease in the overall burden of amputation as a result of better treatment of causative disorders and proper limb salvage techniques. Complications, however, pose challenges in regain of necessary functions and include an array of disorders related to the procedure, technique and other factors. An understanding of common and practical complications is helpful in their anticipation and relevant prohibitive measures. Apart from it, a comprehensive study that highlights pattern of amputations and related complications provides database for preventive and management strategy. A total of 69 cases of extremity amputations were included within a defined period of Jan 2011 to June 2016. Relevant demographic data were noted along with other details amputation and complications. An attempt is also made for co-morbidities associated in cases with complications. Males (88.40%) and lower extremity (66.66%) were involved more commonly than females and upper extremity. Below knee was commonest (50.72%) lower and below elbow along with digital amputations were commonest (15.94% each) upper extremity amputations. The significant complication that required increased hospital stay or additional procedures were noted in 34 (49.27%) cases. Delayed wound healing, wound dehiscence, painful neuroma, stiffness, exposed bone and phantom pain were some of major complication noted in the study. A brief notes on patient characteristics has been attributed to the nature of trauma, co-morbidities and substance abuse among the complicated cases. The early recognition of complication and prompt management goes a long way in abetment of agony and discomfort of patient affecting overall outcome.