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Case Reports
. 2020 Mar;53(1):124-130.
doi: 10.1055/s-0040-1709951. Epub 2020 Apr 24.

Cross-Hand Replantation

S Raja Sabapathy  1 , Hari Venkatramani  1 , Sanjai Ramkumar  1 , Monusha Mohan  1 , Dafang Zhang  2
Affiliations
Case Reports

Cross-Hand Replantation

S Raja Sabapathy et al. Indian J Plast Surg. 2020 Mar.

Abstract

Combined major injury to both upper extremities, in which one hand is amputated and structurally intact but not replantable, and the other hand is unsalvageable, is a rare setting in which cross-hand replantation may be considered. We report a case of an emergency cross-hand replantation performed at the wrist level. In our case, insertions of the wrist flexor and extensor tendons at the second and third metacarpal bases were retained at the recipient, allowing for early active wrist motion and finger motion by tenodesis. Fascicle-specific nerve coaptations were performed. The patient achieved satisfactory functional results, allowing him independence with daily living activities and return to gainful employment. At the time of telemedicine follow-up at 5 years, he was employed full-time, reported no difficulty or mild difficulty with most daily activities, and preferred the use of his replanted hand over a contralateral prosthesis.

Keywords: cross-hand replantation; mangling injury; replantation.

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Conflict of interest statement

DisclosureConflict of Interest The authors have no sources of financial or material funding to disclosure. No portion of this work has been previously presented or published. SRS, HV, and SR were involved in the clinical care of this patient. All authors were involved in the design and conception of this article and the writing and revising process. This study was exempt from institutional board review per our institutional policy on small case reports. Our study was performed in accordance with and conforming to the Declaration of Helsinki. None declared.

Figures

Fig. 1
Fig. 1
Clinical photographs of the injured (a) left upper extremity with segmental loss of metacarpals and near total loss of palmar soft tissue and (b) right upper extremity with amputation through the proximal third of forearm with loss of middle and distal third of forearm. Preoperative radiographs (c), (d) displaying the same.
Fig. 2
Fig. 2
( a ) Intraoperative plain radiograph showing the proposed transfer of the right hand onto the left wrist prior to replantation. ( b ) Postoperative plain radiograph showing the K-wire fixation after cross-hand replantation. ( c ) Intraoperative clinical photograph showing the proposed transfer of the right hand onto the left wrist prior to replantation. ( d ) Intraoperative clinical photograph showing anastomosis of the proximal radial artery to the distal ulnar artery with an interpositional vein graft (white arrow), coaptation of the respective motor and sensory branches of the ulnar nerve (black arrow), and coaptation of the median nerve (yellow arrow).
Fig. 3
Fig. 3
Postoperative clinical photographs ( a–c ) and plain radiographs of the cross-hand replantation ( D, E ).
Fig. 4
Fig. 4
Postoperative clinical photographs showing the patient brushing his teeth, combing his hair, using a cell phone, and eating.
See this image and copyright information in PMC

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