Replantation of amputation at the wrist: challenges of management in sub-Saharan Africa

Abstract

Amputations of the upper limb, in particular, have a major impact on patients’ lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.

Management of tension gastrothorax: experience from sub-Saharan Africa

“…The burden of this clinical recognition and differentiation of the pathologies depends on the primary responders and emergency room physicians. Unfortunately, in sub-Saharan Africa, most of these responders are not specialists,2 hence are poorly trained. A good number of emergency room physicians in the tropics may be trained to identify increased intrathoracic tension but may not be able to discriminate between tension pneumothorax and tension gastrothorax.…”

“…Institution of emergency management immediately following clinical diagnosis is key. However, clinical recognition, especially in the tropics where most of the trauma management is done by non-specialists,2 remains the bane in the management.…”