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Lai WC, Pham C, Chan JP, Lung BE, Rafijah GH. Hand Replantation With Dorsal Spanning Plate Following a Self-Inflicted Radiocarpal Amputation. Cureus 2023; 15:e36656. [PMID: 37102009 PMCID: PMC10123377 DOI: 10.7759/cureus.36656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
Upper extremity amputations represent a prime opportunity to restore function through replantation. There are a variety of options that treating surgeons use to protect neurovascular repairs and restore function including Kirschner wire fixation, external fixation, wrist arthrodesis, and proximal row carpectomy. Additionally, the dorsal spanning plate may be a valuable tool for protecting neurovascular repairs. Compared to temporary immobilization with Kirschner wire fixation, which has previously been described in conjunction with upper extremity replantation, dorsal spanning plates can be left in place for longer durations with a lower risk of loosening and loss of fixation and for preventing postoperative sabotage or repeat amputation of the replant by the patient. In this article, we describe a unique case of a patient with acute psychiatric illness that presented with a self-inflicted amputation through the radiocarpal joint and was initially treated with emergent replantation and application of a dorsal spanning plate to protect the neurovascular repair from patient sabotage and allow for early rehabilitation. We found the dorsal spanning plate to be an effective option in this complex clinical scenario. This case illustrates the utility of the dorsal spanning plate in protecting complex neurovascular repairs in the setting of severe skeletal and psychiatric instability.
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Affiliation(s)
- Wilson C Lai
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Cory Pham
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Justin P Chan
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Brandon E Lung
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Gregory H Rafijah
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
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Corrective Tendon Repair with Local Anesthesia following Wrist-level Replantation. Plast Reconstr Surg Glob Open 2022; 10:e4218. [PMID: 35317463 PMCID: PMC8929524 DOI: 10.1097/gox.0000000000004218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Wide-awake local anesthesia with no tourniquet has become a popular method to ensure correct tendon condition intraoperatively. We report the case of a 17-year-old man who underwent nearly total left wrist amputation and successful replantation. The misconnection of flexor tendons between the thumb, index, and middle finger was found postoperatively. At 1.5 months postreplantation, simultaneous tenolysis and corrective tendon repair were performed under local anesthesia. The proximal tendon origins were confirmed intraoperatively with the patient awake. Six months after replantation, the patient underwent extensor pollicis longus tendon shortening and pulley reconstruction under wide-awake local anesthesia with no tourniquet for thumb extension lag. After adequate rehabilitation, the functional outcome was satisfactory. This case report demonstrates that local anesthesia is a judicious method to intraoperatively facilitate correct tendon repair, tension adjustment, and direct conversation between the surgeon and the patient.
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Heineman J, Bueno EM, Kiwanuka H, Carty MJ, Sampson CE, Pribaz JJ, Pomahac B, Talbot SG. All hands on deck: Hand replantation versus transplantation. SAGE Open Med 2020; 8:2050312120926351. [PMID: 32537157 PMCID: PMC7268554 DOI: 10.1177/2050312120926351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives: Our hands play a remarkable role in our activities of daily living and the
make-up of our identities. In the United States, an estimated 41,000
individuals live with upper limb loss. Our expanding experience in limb
transplantation—including operative techniques, rehabilitation, and expected
outcomes—has often been based on our past experience with replantation.
Here, we undertake a systematic review of replantation with transplantation
in an attempt to better understand the determinants of outcome for each and
to provide a summary of the data to this point. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines, we conducted PubMed searches from 1964 to 2013 for articles in
English. In total, 53 primary and secondary source articles were found to
involve surgical repair (either replantation or transplantation) for
complete amputations at the wrist and forearm levels. All were read and
analyzed. Results: Hand replantations and transplantations were compared with respect to
pre-operative considerations, surgical techniques, post-operative
considerations and outcomes, including motor, sensation, cosmesis, patient
satisfaction/quality of life, adverse events/side effects, financial costs,
and overall function. While comparison of data is limited by heterogeneity,
these data support our belief that good outcomes depend on patient
expectations and commitment. Conclusion: When possible, hand replantation remains the primary option after acute
amputation. However, when replantation fails or is not possible, hand
transplantation appears to provide at least equal outcomes. Patient
commitment, realistic expectations, and physician competence must coincide
to achieve the best possible outcomes for both hand replantation and
transplantation.
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Affiliation(s)
- John Heineman
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ericka M Bueno
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Harriet Kiwanuka
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Carty
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian E Sampson
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian J Pribaz
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Kempny T, Knoz M, Lipovy B, Priol A, Holoubek J. The use of a Gore-Tex prosthesis to stabilise venous drainage in an amputated distal forearm replantation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Satria O, Abubakar I, Mahendra Karda IW. Replantation at the level of the wrist joint: A case report. J Clin Orthop Trauma 2019; 10:873-878. [PMID: 31528060 PMCID: PMC6739268 DOI: 10.1016/j.jcot.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022] Open
Abstract
Upper extremities amputations are devastating injuries that have a major impact on patients' quality of life. Replantation after traumatic amputation is often performed to obtain limb recovery. Following the high survival rate of replantation of post-traumatic hand amputation, recent emphasis has now shifted to functional recovery rather than survival only. Wrist replantation remains a challenging procedure for orthopaedic and hand surgeon. We reported a case of a 25-year-old male with traumatic amputation of the right hand.
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Affiliation(s)
| | - Irsan Abubakar
- Department of Orthopaedics & Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
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6
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Watson L, Beem H, Rowe K, Senewiratne S. Late hand replantation with restoration of intrinsic muscle function: a case and review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Functional assessment and quality of life in patients following replantation of the distal half of the forearm (except fingers): A review of 11 cases. HAND SURGERY & REHABILITATION 2017; 36:261-267. [DOI: 10.1016/j.hansur.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/19/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
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Mattiassich G, Rittenschober F, Dorninger L, Rois J, Mittermayr R, Ortmaier R, Ponschab M, Katzensteiner K, Larcher L. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskelet Disord 2017; 18:77. [PMID: 28187720 PMCID: PMC5303287 DOI: 10.1186/s12891-017-1442-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background Amputations in general and amputations of upper extremities, in particular, have a major impact on patients’ lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. Methods Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. Results Twelve male and four female patients with an average age at injury of 40.6 years (range, 14–61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4–32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2–94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120–126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. Conclusions We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.
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Affiliation(s)
- G Mattiassich
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria. .,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. .,Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern - Teaching hospital of the Paracelcus Medical University Salzburg, Linz, Austria.
| | - F Rittenschober
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Dorninger
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - J Rois
- Trauma Center Vienna Meidling, Vienna, Austria
| | - R Mittermayr
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Trauma Center Vienna Meidling, Vienna, Austria
| | - R Ortmaier
- Department of Trauma Surgery, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | - M Ponschab
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria.,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - K Katzensteiner
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Larcher
- Trauma Center Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Plastic, Aesthetic and Reconstructive Surgery Sanitaetsbetrieb South Tyrol (SABES), Bolzano, Italy
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Nayak BB, Mohanty N, Patnaik AP, Bal PK. Considerations for double-hand replantation in a resource-constrained healthcare facility. Indian J Plast Surg 2016; 49:81-5. [PMID: 27274127 PMCID: PMC4878250 DOI: 10.4103/0970-0358.182233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Bilateral-hand amputation is extremely rare and double-hand replantation is even rarer. Only one case of successful double replantation at arm level has been reported from India. We present a case of double-hand replantation at proximal palmar level in a young adult executed in a small nursing home. The patient presented 5 h after injury with limbs preserved well in ice. There were difficulties in executing such an unusual case in a small nursing home set-up. The patient is performing his activities of daily living and basic functions independently. We share our experience of this double-hand replantation with special emphasis on problems encountered.
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Affiliation(s)
| | - Nilamani Mohanty
- Department of Plastic Surgery, S.C.B. Medical College, Cuttack, Odisha, India
| | | | - Prasanta Kumar Bal
- Department of Plastic Surgery, S.C.B. Medical College, Cuttack, Odisha, India
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10
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Cavadas PC, Thione A, Rubí C. Hand Amputations at the Radiocarpal Level With Proximal Neuromuscular Avulsion. J Hand Surg Am 2016; 41:70-5. [PMID: 26710737 DOI: 10.1016/j.jhsa.2015.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report a series of 6 radiocarpal avulsion amputations in 5 patients. METHOD We replanted 6 radiocarpal amputations in 5 patients with proximal musculotendinous and nerve avulsion between 2005 and 2013 and reviewed them retrospectively. All 5 patients were men, age range from 21 to 32 years. Functional results were evaluated through total active motion (TAM) of the fingers, 2-point discrimination, monofilament test, grip strength, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Follow-up was 4 to 10 years. RESULTS All replanted parts survived without systemic complications. No infections or major wound complications occurred despite the preservation of presumably avascular tendons. The functional results of the right side in patient 1 who suffered bilateral amputations, were very modest, with only 360° of TAM (about 30% of the TAM of a normal hand) and weak grip after 5 secondary surgical procedures including 2 free functional gracilis transfers. This was the only hand in which the tendons were not reinserted primarily. The other hands achieved TAM between 590 and 820°, which corresponds roughly to 50% to 70% of the normal TAM of a healthy hand, and mean of 10-kg grip force. CONCLUSIONS Radiocarpal amputation with proximal musculotendinous avulsion is an infrequent pattern of injury in which replantation with tendon reinsertion can yield functional results comparable with those reported for sharp wrist-level amputations. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Pedro C Cavadas
- Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain
| | - Alessandro Thione
- Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain.
| | - Carlos Rubí
- Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain
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11
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Patel AA, Blount AL, Owens PW, Askari M. Functional outcomes of replantation following radiocarpal amputation. J Hand Surg Am 2015; 40:266-70. [PMID: 25499843 DOI: 10.1016/j.jhsa.2014.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the long-term functional and clinical outcomes of patients who have undergone replantation after radiocarpal amputation. METHODS We performed a retrospective review of radiocarpal joint amputations at a level 1 trauma center over a 13-year period. Medical records of patients treated with replantation were queried for injury data, operative reports, complications, and clinical progress. Patients who met inclusion criteria were contacted for long-term follow-up. We measured total active motion of each digit, strength (grip and pinch), and 2-point discrimination. Functional outcomes were assessed with Disabilities of Arm, Shoulder, and Hand score, Mayo Wrist Score, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire. Descriptive statistics were calculated, including frequencies for categorical variables and means and ranges for continuous variables. RESULTS Six patients met the inclusion criteria. The mean age was 36 years (range, 26-50 y). Five patients were available at a mean follow-up of 3.9 years (range, 1.0-6.9 y). Compared with the contralateral uninjured extremity, total active motion of the hand was 38% (range, 26% to 59%) and grip strength was 9% (range, 0% to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6 mm (range, 8-12 mm). All mean outcome scores indicated moderate disability, including Disabilities of Arm, Shoulder, and Hand (76; range, 45-82), Mayo Wrist Score (23; range, 5-50), Patient-Rated Wrist Evaluation (86; range, 56-98), and Michigan Hand Questionnaire (27; range, 15-55). Two patients were able to return to work and 3 were permanently disabled. All patients were satisfied with the hand function. CONCLUSIONS Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Amar Arun Patel
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Andrew L Blount
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Patrick W Owens
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Morad Askari
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
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Thirty-Year Follow-up of Total Hand Replantation: A Case Report. Ann Plast Surg 2014; 76:521-3. [PMID: 25046672 DOI: 10.1097/sap.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The loss of a limb is a devastating yet relatively common injury with a vast panoply of effects. Beyond the obvious potential for the loss of livelihood are profound social, psychological, and aesthetic consequences. Thus, despite significant improvements in functional prostheses and rehabilitation for traumatic hand amputations, the option for replantation should always be carefully considered. We present a case of a total hand replantation at the level of the wrist performed 30 years ago, which to our knowledge exceeds the longest reported follow-up by 11 years. The excellent outcome observed in this patient demonstrates the importance of presurgical planning and analysis of the amputated segment, the utility of therapy, and the durable functionality of extremity replantation over an extended period.
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Abstract
BACKGROUND Upper extremity replantation is a procedure that has revolutionized hand surgery. Since its introduction, a rapid evolution has occurred with a shifting focus from implant survival to optimization of functional outcomes and surgical efficiency. In this review, the current concepts surrounding the indications for replantation, variations in surgical technique, the factors affecting outcomes, and future directions of the specialty are analyzed. METHODS A literature review was performed of all recent articles pertaining to digit, hand, and upper extremity replantation surgery. Particular emphasis was placed on comparative studies and recent meta-analyses. RESULTS The indications and contraindications for replantation surgery are largely unchanged, with mechanism of injury remaining one of the most important determinants of implant survival. With advances in surgical technique, improved outcomes have been observed with avulsion injuries. Distal tip replantations appear to be more common with improved microsurgical techniques, and for these distal injuries, digital nerve and vein repair may not be necessary. Cold ischemia time for a digit amputation should not preclude transfer to a replantation facility or significantly affect the decision to perform a replantation. However, transferring physicians should thoroughly review the options with patients to prevent unnecessary transfers, which is an area where telemedicine may be useful. CONCLUSION This review provides an update on the current concepts of the practice of replantation and the treatment and management of patients with upper extremity amputations.
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Wang W, Liu S, Liu J, Ruan H, Cai Z, Fan C. Modified Sauvé-Kapandji procedure for restoration of forearm rotation in devascularized hands. Ir J Med Sci 2014; 183:643-7. [PMID: 24470183 DOI: 10.1007/s11845-014-1067-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauvé-Kapandji (S-K) procedure. METHODS This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. The mean patient age was 35 (range 19-45) years. Mean time to reconstruction was 2.5 (range 0.5-4) years. RESULTS Mean postoperative pronation was 74°; mean postoperative supination was 80°. Overall results were excellent/good in seven patients, fair in one, and poor in one. No bone bridge was formed between the pseudarthrosis in any patient. Two patients had neurapraxia. Moderate pain and snapping occurred in one patient during movement at the ulnar amputation site. CONCLUSION This modification of the S-K procedure can restore rotation of the forearm after hand revascularization; as such, it provides an alternative salvage procedure.
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Affiliation(s)
- W Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, People's Republic of China
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Mahajan RK, Mittal S. Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience. Indian J Plast Surg 2014; 46:555-60. [PMID: 24459349 PMCID: PMC3897104 DOI: 10.4103/0970-0358.122018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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 years to 55 years. Out of 17 patients,16 were males. All the replantations were successful except for one. Summary: The results showed that, although the replanted hands were never functionally as good as the contralateral hand the patients were able to perform most of the daily activities.
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Affiliation(s)
- Ravi Kumar Mahajan
- Department of Plastic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Seema Mittal
- Department of Plastic Surgery, Amandeep Hospital, Amritsar, Punjab, India
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16
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Abstract
Since the first successful salvage of an amputated finger using microsurgical anastomoses in 1965, replantation 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.
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Affiliation(s)
- Pao-Yuan Lin
- Division of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan
| | - Seng-Feng Jeng
- Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Tsan-Shiun Lin
- Division of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan
| | - Ching-Hua Hsieh
- Division of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan
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17
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Rtshiladze MA, Andersen SP, Nguyen DQA, Grabs A, Ho K. The 2009 Sydney shark attacks: case series and literature review. ANZ J Surg 2011; 81:345-51. [PMID: 21518184 DOI: 10.1111/j.1445-2197.2010.05640.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There were 59 unprovoked shark attacks worldwide in 2008. Twelve of these occurred in Australia, ranking it as second only to the USA. In February 2009, two attacks occurred within 72 h in Sydney, Australia. METHODS The two patients involved survived severe limb trauma. Case 1 suffered bite trauma to the lower limb and hand and underwent staged debridement and early amputation. Case 2 presented with a hand severed at the level of the wrist that was initially replanted. However, it would succumb to progressive necrosis after 12 days. We discuss the aspects of these cases that contributed to the patients' survival and ultimately good functional outcomes. DISCUSSION New paradigms for the management of major trauma patients have emerged over the last decade. We consider recent advances in the understanding of pre-hospital tourniquet use, rapid transit to the operating suite and damage control surgery, and examine how they impacted on the management of our patients. Very little is known about the microbiology of shark bites. Organisms from sea water, the patient's skin and the shark's mouth must all be considered when selecting appropriate antimicrobial prophylaxis. The planning of definitive surgery in severe limb trauma is dependent on the interactions of a number of factors including physical, psychological and social issues. The decision to ultimately replant or amputate the effected limb is best made in union with the patient and their family.
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18
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Hoang NT, Staudenmaier R, Feucht A, Klöppel M, Hoehnke C. [Microsurgical thumb replantation following traumatic amputation: preliminary results in Hanoi, Vietnam]. Unfallchirurg 2009; 112:1047-54. [PMID: 19844669 DOI: 10.1007/s00113-008-1533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Replantation using microsurgical techniques is a fairly new procedure in Vietnam. We reviewed and evaluated our 7-year results of thumb replantation in Vietnamese patients following traumatic thumb amputation. MATERIAL AND METHODS Traumatic thumb amputations between September 1999 and July 2006 were reexamined and evaluated. Postoperative functional results were evaluated based on four main criteria: 1) the patient's subjective attitude regarding the replanted thumb, 2) the degree of mobility of the replanted thumb compared with its counterpart, 3) the level of sensitivity of the replanted thumb, and 4) the objective ability to perform daily tasks. RESULTS A total of 26 patients were documented. The duration of follow-up averaged 22 months (range 6-72 months). The success rate of replantation was 81%. A rating of either "good" or "very good" was obtained for 81% of the replanted thumbs. DISCUSSION Vascular thrombosis was the cause of all failures. Proper debridement, standardized microvascular techniques, timely detection of thrombosis formation, and reoperation using vein grafts play a decisive role in the final success.
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Affiliation(s)
- N T Hoang
- Department of Hand surgery and Microsurgery, Institute of Trauma and Orthopaedics, Central University Hospital, Hanoi, Vietnam.
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Effectiveness of free gracilis muscle flaps in the treatment of chronic osteomyelitis with purulent fistulas at the distal third of the tibia in children. J Pediatr Orthop 2009; 29:305-11. [PMID: 19305285 DOI: 10.1097/bpo.0b013e31819903e1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic purulent infection at the distal third of the tibia resulting from of a previous hematogenous osteomyelitis in children is a severe infection which is seldom reported in the literature and remains a difficult challenge for orthopaedic surgeons. METHODS A 6-year retrospective review from September 2001 to October 2006 (institutional review board-approved) was performed to evaluate postoperative surgical results of this type of infection using a free gracilis muscle flap. RESULTS A total of 6 children with an average age of 9.8 years were included. The infective period of purulent fistulas ranged from 6 to 31 months (mean 17.7). Staphylococcus aureus were reported in all wounds (6/6) and were commonly combined with Escherichia coli (5/6). All of the free gracilis muscle transfers were successful (6/6 flaps). No postoperative recurrence of infection was observed with an average postoperative follow-up period of 3 years. All patients were also able to satisfactorily demonstrate walking and standing functions. CONCLUSIONS Both the radical debridement of infected tissues and restoration of ample blood supply using free muscle flaps are the keys to success. Based on its favorable form, the free gracilis muscle flap can be considered a suitable muscle for use in reconstruction. LEVEL OF EVIDENCE IV.
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Woo SH, Lee YK, Lee HH, Park JK, Kim JY, Dhawan V. Hand replantation with proximal row carpectomy. Hand (N Y) 2009; 4:55-61. [PMID: 18855073 PMCID: PMC2654953 DOI: 10.1007/s11552-008-9141-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 09/24/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to present our operative technique and postoperative results of the hand replantation with proximal row carpectomy in cases of complete amputation at the level of wrist joint. From May 2003 to April 2005, five patients suffered from complete amputation of the hand due to industrial trauma. Amputation level was radiocarpal joint in three cases and midcarpal joint in two cases. Three cases represented guillotine type and two cases with local crush type injuries. All were men and the mean age was 26.6 years. The mean follow-up period was 26.8 months. At the time of replantation, the wrist joint was stabilized with transarticular fixation using three to four Kirschner's wires after performing proximal row carpectomy. Postoperatively, functional results such as muscle strength, range of motion of the wrist and fingers, and sensory recovery were assessed according to Chen's criteria. Joint width and arthritic changes of the radio-capitate joint were evaluated with radiologic tools. According to Chen's criteria, the overall results in five cases were classified as grade II. Intrinsic muscle power of hands was found to be grade 4. The mean grip and pinch powers were 41% and 45%, respectively, compared to contralateral hand. The mean arc of flexion-extension of wrist was 53 degrees . Total mean active motion of fingers was 215 degrees. Static two-point discrimination of fingertip ranged from 8 to 13 mm. On the follow-up, computerized tomography showed well-preserved radio-capitate joint space without any arthritic changes. While performing hand replantation after amputation at the radiocarpal or midcarpal level, proximal row carpectomy is a useful procedure to preserve joint motion of the wrist in selected cases.
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Affiliation(s)
- Sang-Hyun Woo
- Woo & Lee's Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101-6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902, South Korea.
| | - Young-Keun Lee
- Woo & Lee’s Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101–6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902 South Korea
| | - Hang-Ho Lee
- Woo & Lee’s Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101–6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902 South Korea
| | - Ji-Kang Park
- Woo & Lee’s Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101–6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902 South Korea
| | - Joo-Yong Kim
- Woo & Lee’s Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101–6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902 South Korea
| | - Vikas Dhawan
- Woo & Lee’s Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101–6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902 South Korea
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Merrell G, Heard W, Park MJ, Ramos P, Dasilva MF. Carpal growth and function after pediatric transcarpal hand replant: case report. J Hand Surg Am 2008; 33:1354-7. [PMID: 18929200 DOI: 10.1016/j.jhsa.2008.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/20/2008] [Accepted: 04/23/2008] [Indexed: 02/02/2023]
Abstract
This case discusses the technique, postoperative course, and functional outcomes 5 years after an amputation between the cartilaginous anlages of the growing carpus in a 7-year-old boy. The lunate remained attached to the arm, whereas the scaphoid and the remainder of the carpus were contained within the amputated part. After 5 years, the patient had 94% growth compared to the other side, a Minnesota dexterity test in the 75th percentile, 0/10 pain, near-normal sensation, grip strength 17% of the other side, and lateral pinch 79% of the other side.
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Affiliation(s)
- Greg Merrell
- Indiana Hand Center, Indianapolis, IN 46260, USA.
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Abstract
Since Malt and McKhan's first successful arm replantation in 1962, upper extremity replantation surgery techniques have been refined and spread worldwide. Nevertheless, replantation at or proximal to the wrist, referred to as wrist-proximal replants, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.
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Affiliation(s)
- Douglas P Hanel
- Section of Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-6499, USA.
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