Successful Hand Replantation in a Case of Total Avulsion without Vein Graft

Abstract

Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation-a completely amputated hand-by vascular anastomosis technique was successfully performed.¹ Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.² in 1968. The overall success rate of limb replantation surgery is around 83.2%.³ The mechanism of injury plays a role in the outcome; guillotine amputations-for example-carry a better prognosis than crush amputations.⁴ We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his hand successfully with good functional outcome.

Fig. 1.

Intraoperative showing the stump part and amputation part.

Fig. 2.

Preoperative plain x-ray showing the amputated hand and stump with multiple-level fractures.

Fig. 3.

Postoperative plain x-ray showing the fixation with maintained alignment of the wrist joint.

Fig. 4.

Postoperative 3 months later after removal of K-wires at the clinic.