An ultra-short series of hand replants in quick succession

S. Skanda1, Muralidhasan2, Shylesh Ranesh Babu2, Preethivaradhan R. S3, Pratheep S3

1Head of the Department – Plastic Surgery, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Consultants – Plastic Surgery, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Senior Superspeciality – DrNB Residents, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Case Overview

A few months ago, we had a series of three hand replants of varying difficulties.

One had a trans metacarpal crush avulsion amputation sustained in a power press. The other two were assault injuries, with one amputation oblique through the distal carpal row sparing the thumb while the last was through the wrist.

Management

For the crush amputation, two dorsal veins and the common digital arteries – index/ mid and ring/little finger plus the ulnar side digital artery of little finger were done separately.

For the oblique amputation which was the most challenging, three separate digital artery anastomosis and two dorsal veins were connected.

In the wrist level amputation, both radial and ulnar arterial anastomoses done and three dorsal veins – one over the thumb and one in the center and one on the ulnar side were anastomosed.

Conclusion

All three did well, and are improving with physiotherapy day by day.

The interesting thing about all three replants were that all three were clustered in a gap of 10 days! The first two was within four days of each other and the last was six days after the second one.

These three patients became good friends in hospital and each motivated the other, engaging in friendly competition to get back near normal function.

Here are the before and after images of all three as a collage.

Replantation is one of the most mentally taxing surgeries for us, and brings a lot of goodwill from all sides for this.

The best modality of reconstruction of the hand post a complete amputation still remains replantation, and with good technique, near normal functional results can be achieved in most situations. Replantation must always be attempted in hand amputations as no prosthesis can replace the function of a human hand completely.

Before

After

Kauverian Bookshelf

Applied Medical Statistics

Journals

Kauvery Hospital
Find Doctor
Book Appointment