Current Procedures in Hand Replantations - Particular Level of Traumatic Upper Limb Amputation

Abstract

Amputations in the upper extremity due to trauma are, by definition, devastating injuries that involve multiple critical structures of the fingers, hand, arm, or any combination of the three and nearly always lead to significant disabilities, both directly and through their psychosocial impact. Replantation is defined as the reattachment of a part that has been completely cut off and the reconnection of the damaged vascular structures. Chances of viability depend on the degree of vascular, bone, muscle and nerve lesions, the level of amputation, the trauma mechanism, the pacient’s age and comorbidities, the ischemia time while the functional recovery is assessed according to the following criteria: the active range of motion, the two-point discrimination sensibility ratings, the grip and pinch strength, the cold intolerance, and the return to previous employment. We report a case of a man D.V., aged 51, with a non-pathological personal history, admitted in April 2014 in the Emergency Hospital of Bucharest with the diagnostic “Severe injury by circular right upper limb. Hand amputation from radiocarpal joint, 3 hours old”. The pacient was urgently transported in the operating room, where the right hand replantation was performed. He was first hospitalized in the Intensive Care Unit, then he was transferred in the Plastic Surgery and Reconstructive Microsurgery Clinic. Post-operatively, the results were favorable, our patient achieved at 6 months evaluation S3+ and M4 on British Medical Research Council‘s scale.