Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Abstract

Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management. Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases. Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation. Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

Functional Outcome Following Hand and Wrist Level Replantation: A Retrospective Review

“…Reports about secondary surgeries following replantation of major parts are also frequent [6,15,16]. Avoiding trans-fixation of the tendons and joints, early removal of hardware, and early motion can help reduce the number of secondary interventions [15,17]. Timing of secondary interventions is also critical, any bone nonunion should be addressed early, while adequate time should be allowed for tissue equilibrium before undertaking tenolysis.…”

The Role of External Fixation in the Management of Upper Extremity Fractures

“…Finally, external fixation has also shown benefit in the management of replantations and early motion protocols. Harrison et al 39 described their technique for replantation of a Zone IV amputation using a rigid external fixation across the forearm and hand, which allowed for an early active range-of-motion protocol, which they noted may decrease the need for future surgical procedures.…”