A Unique Case of Replantation of Previously Replanted Fingers (original) (raw)
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Indian Journal of Plastic Surgery, 2011
Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twentyone fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied with the functional outcome and aesthetic appearance. This article highlights the technical considerations and the outcome of these fingertip replants.
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.
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.
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.
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.
Rehabilitation after successful finger replantations
İstanbul Kuzey Klinikleri, 2016
OBJECTIVE: The aim of the present study was to assess results of rehabilitation of patients after finger replantation. METHODS: The study examined 160 fingers amputated and replanted at various levels between 2000 and 2013 at the clinic. Mean patient age was 29.4 years. Mean follow-up time was 23 months. Rehabilitation of fingers began between postoperative fourth and eighth week and continued until the 24th week. Range of motion of affected hand, return to daily activities, aesthetic appearance, and patient satisfaction were assessed according to Tamai criteria. RESULTS: Functional results according to Tamai criteria were perfect in 36 patients, good in 54 patients, average in 27 patients, and poor in 18 patients. CONCLUSION: Post-operative rehabilitation of replanted fingers should begin as soon as possible. During the rehabilitation period, physiotherapist, surgeon, and patient must work in close cooperation. Functional results of patients who adjust to the rehabilitation program, home practice, and splint usage are better.
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.
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.
Late results of replantations in tip amputations of the thumb
Acta Orthopaedica et Traumatologica Turcica, 2008
Amaç: Başparmak Tamai tip 1 amputasyonlarda uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Çalışmaya, başparmak tırnak yatağı distalinde meydana gelen Tamai tip 1 amputasyonlar nedeniyle replantasyon uygulanan ve tedavi sonrasında dolaşım devamı sağlanan 14 hasta (12 erkek, 2 kadın; ort. yaş 28; dağılım 14-40) alındı. Tüm hastalarda santral digital arter anastomozu yapıldı. Anastomoza uygun ven bulunabilen dört hastada birer adet volar ven anastomozu yapıldı. Sinir tamiri sadece üç hastada yapılabildi. Duyu değerlendirmesi Semmes-Weinstein testi, iki nokta ayrım testi, hareketli iki nokta ayrım testi ve vibrasyon testi ile yapıldı; ayrıca, hastalar parmak atrofisi, soğuk intoleransı ve tırnak yatağı deformiteleri açısından incelendi. Ortalama takip süresi 11 ay (dağılım 6-48) idi. Sonuçlar: Semmes-Weinstein testi beş parmakta (%35.7) yeşil (dağılım 2.83-3.22), sekiz parmakta (%57.1) mavi (dağılım 3.22-3.61), bir parmakta (%7.1) mor (dağılım 3.84-4.31) idi. İki nokta ayrım testi ortalama skoru 6.9 mm (dağılım 3-11 mm), hareketli iki nokta ayrım testi ortalama skoru 4.5 mm (dağılım 3-6 mm) bulundu. Aynı elin sağlıklı parmaklarıyla karşılaştırıldığında, vibrasyon altı başparmakta (%42.9) artmış, altı başparmakta azalmış bulunurken, iki başparmağın (%14.3) vibrasyonu diğer parmaklarla eşit idi. Beş parmağın (%35.7) replante edilen kısmında atrofi; üçer hastada (%21.4) ise soğuk intoleransı ve tırnak deformitesi görüldü. Hastaların işe dönüş süreleri ortalaması 3.2 aydı (dağılım 2-6 ay). Çıkarımlar: Başparmak distal uç replantasyonları, teknik zorluklara rağmen, görünüm açısından ve fonksiyonel açıdan iyi sonuçlar vermektedir. Sinir tamiri yapılamayan olgularda da yeterli duysal iyileşme sağlanmaktadır.
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.