Trans-metacarpal hand replantation – case report

Abstract

A 53-year old patient amputated his hand with a sheet metal guillotine while working in a workshop. After a preliminary assessment consisting of running diagnostics and wound dressing, he was transported and admitted to the Department of Orthopaedics and Traumatology of the Medical University of Gdańsk. The initial surgery took 8 hours. The microsurgical procedures consisted of anastomosis of the ulnar artery and three superficial veins. The radial artery remained unidentified. Ulnar, median and dorsal branch of the radial nerve neurorrhaphy was performed. Flexor and extensor tendons were sutured according to the standard protocol. Metacarpal osteosynthesis using K-wires, nail matrix perforation and forearm fasciotomy were performed. The patient was equipped with a cast. Antibiotics, fluids, LMWH and hyperbaric oxygen therapy were administered. While hospitalized, the patient experienced necrosis of the first radius and II finger as a result of insufficient arterial flow. Reamputation of the necrotic parts was necessary. As a result of immense tissue shortage, the defect was covered with a superficial inferior epigastric artery tubed flap. After detaching the dermal-tubed flap, the patient was treated in an outpatient clinic. He later returned to the Department several more times due to delayed wound healing. In the course of treatment, as well as reamputation of fingers I and II, a number of redressions were performed.

Non-microsurgical replantation (composite graft with palmar pocketing) – a case report of successful reintegration of distal finger amputation

“…However, considering absence of biological contraindications and patient's high aesthetic expectations we decided to contact the Replantation Service. e communication protocol was executed [1] and crucial feedback was given -a recommendation to perform composite gra ing followed by palmar pocketing. Stage-1 surgery was performed 4 hours a er the injury.…”