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Traumatic Amputation on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Akash Kumar Ghosh, Vishal Kumar
Replantation is usually done only for upper limb amputation, as prosthesis acceptance is greater for lower limb amputations. A patient planned for replantation should be shifted to the operating theatre without any delay.
Amputations and ring avulsions
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Factors that influence the outcome are the extent of crush injury to the blood vessels, whether the patient is a smoker, and the total ischemia time. A replantation should always be performed by an experienced hand surgeon. An honest discussion about the functional result of an replantation is warranted.
Injuries of the hand
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The thumb should be replanted whenever possible. Even if it functions only as a perfused ‘post’ with protective sensation, it will give useful service. Multiple digits also should be replanted, and in a child even a single digit. Proximal amputations (through the palm, wrist or forearm) likewise merit an attempt at replantation.
A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Xianyu Zhou, Di Sun, Fei Liu, Wen Jun Li, Chuan Gu, Ling Ling Zhang
A 29-year-old female had a palmar oblique amputation with injury type of PNB 455 [18,19] (Figure 2(A)) in the right index finger (Figure 2(B–D)). Replantation was impossible as the distal amputation was unfound. Radiography, tetanus antitoxin, analgesic, antibiotics, biological dressing and laboratory tests were routinely administrated. Sub-emergent reconstructive surgery was performed. A size of 2.5 × 2.0 cm osteo-onychocutaneous free flap was designed preoperatively in the left hallux (Figure 2(E,F)). Composite flap was dissected and checked for blood perfusion by releasing of tourniquet intraoperatively (Figure 2(G)). The donor site was primarily closed with the medial flap strip after flap harvest (Figure 2(H)). After proper flap fixation, the vessels and nerve were repaired. The injured index finger was well reconstructed and reperfusion was robust immediately (Figure 2(I–K)). At follow-up of 16 months, satisfactory shape in the pulp and nail was achieved (Figure 2(L–N)). No obvious morbidity was found in the donor hallux (Figure 2(O,P)). Static 2-PD was approximately 9 mm. Key-pinch strength was 82% of that of the intact left index finger. The highest score, nine points, was recorded for both the donor and recipient sites.
Does pediatric hand transplantation undermine a child’s right to an open future?
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Jordan MacKenzie, Gennaro Selvaggi, Paolo Sassu
Pediatric transplantation may initially seem similar to pediatric replantation, which is not considered an experimental procedure. Nevertheless, there are several salient differences between the two procedures. Hand transplantation requires a more multi-disciplinary approach, involving more complex organization, than is involved in replantation. As well, during a transplantation, surgeons must deal with bone mismatch, muscle atrophy, and some degree of tissue fibrosis [10]. These factors are not present in the replantation case, and they serve to make the functional results of hand transplantation uncertain. The data on adult hand transplantation and replantation suggest that pediatric transplant recipients will require more post-surgical support than replanted patients, including immunosuppression (if not already immunosuppressed), rehabilitation, occupational therapy, and psychological support [11]. Conversely, some of the risks associated with pediatric replantation will not be present in the transplantation case. Replantation is often performed under emergency conditions, whereas transplantation allows for advance planning. Given these differences, we suggest that data on adult hand transplantation can give us a more accurate, but still very incomplete, picture of the risks and benefits of pediatric hand transplantation.
Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Satoshi Yanagibayashi, Akio Nishijima, Ryuichi Yoshida, Kaoru Sasaki, Naoto Yamamoto, Megumi Takikawa
In our initial two cases, we added a single oblique K-wire fixation due to concern about rotation of the replanted digit. After osteosynthesis, the process of digital replantation was performed with microsurgical techniques in all cases. In the process of replantation, the flexor tendon was directly repaired by end-to-end suture in Tamai zones II and III. The combination of an early active motion protocol [10] and a passive motion protocol in a dorsal splint [11] was started by postoperative day 7, regardless of the presence or absence of tendon repair. The dorsal splint was placed for three weeks after replantation. At the same time, patients were permitted limited use of the injured hand without the dorsal splint, including the injured digit, in daily life when engaged in activities such as washing the face or hands and putting on clothes. Total active motion (TAM) of affected digits was measured after 6 months postoperatively (Table 1).