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Case Reports
. 2023 Sep:110:108627.
doi: 10.1016/j.ijscr.2023.108627. Epub 2023 Aug 9.

Successful management of an amputated hand at the distal row level of carpal bones in low-resources country: A case report

Muhamad Zakaria Brimo Alsaman  1 , Mohamad Nabhan Sawas  2 , Hosam Chahada Al Mohamad  3 , Fateh Mahmoud Hajkhalaf  4 , Muhammad Mokresh  5 , Fadi Mwafak Alerr  6
Affiliations
Case Reports

Successful management of an amputated hand at the distal row level of carpal bones in low-resources country: A case report

Muhamad Zakaria Brimo Alsaman et al. Int J Surg Case Rep. 2023 Sep.

Abstract

Introduction: Hand replantation (HR) surgery is a delicate and complex procedure that requires a multidisciplinary team (MT) and specialized equipment, as well as factors such as ischemia time and injury mechanism that can impact the procedure's potential complications and success rate. We present the first case of successful management within a low-resources setting of an amputated hand in Syria.

Presentation of case: A 20-year-old male presented to the emergency department with an amputated left hand at the distal row of carpal bones (CB) with sharp edges. We first managed the condition by stopping the bleeding and washing the hand with saline. The MT performed a ten-hour surgery to reattach the hand using external fixation and vascular, orthopedic, and neurosurgical procedures. The patient was discharged seven days after surgery and had regular follow-ups for two years and seven months, which showed normal sensory evaluation and mild numbness in the ulnar side of the dorsal side of the palm.

Discussion: HR surgery is challenging and requires an MT and appropriate equipment. Also, amputated hand management requires a specialized center, which was absent in our settings. Hence, the outcome of the surgery was excellent, considering the traditional and old-fashioned techniques followed to establish such an operation in a low-resources country.

Conclusion: Precise preoperative, intraoperative, and postoperative procedures, besides long-term follow-up, are crucial to ensure HR surgery success and effectiveness, in addition to the patient's recovery.

Keywords: Amputation; Case report; Hand; Multidisciplinary team; Replantation.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The amputated part.
Fig. 2
Fig. 2
A. Arm X-ray revealed total distal-row CB amputation. B. C-Arm X-ray after the replantation.
Fig. 3
Fig. 3
A. The arteries and veins Isolation process. The red arrow indicates the ulnar artery, the black arrow indicates the dorsal branch of the radial artery, and the blue arrow indicates the dorsal superficial palmar branch. B. The vascular anastomosis process. The black arrow indicates the ulnar artery and the blue arrow indicates the dorsal branch of the radial artery.
Fig. 4
Fig. 4
A. The external fixation process. B. The tendon isolation process.
Fig. 5
Fig. 5
A. The hand shape after the surgery. B. The hand shape during the follow-up.
See this image and copyright information in PMC

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