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      Partial hand replantation using free microsurgical replantation with staged heterotopic banking of amputated parts: towards improving long term outcomes

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          Abstract

          In hand trauma, the uninjured forearm has been touted as the ideal site for ectopic banking in digit/hand amputations. Here, we describe the temporary ectopic implantation and subsequent replantation of a partially amputated hand and highlight the “ Three R’s” – Recovery, Rehabilitation, and Revision over the first year of recovery.

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          Most cited references15

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          Digit and hand replantation.

          Alexandros Beris, Marios Lykissas, Anastasios Korompilias … (2010)
          For the past 45 years, the advent of microsurgery has led to replantation of almost every amputated part such as distal phalanx, finger tip, etc. Replantation of digits and hand can restore not only circulation, but also function and cosmetic of the amputated part. The goals of replantation are to restore circulation and regain sufficient function and sensation of the amputated part. Strict selection criteria are necessary to optimize the functional result. The management of this type of injuries includes meticulous preoperative management, microsurgical experience and continuous postoperative care. Among various factors influencing the outcome, the most important are the type and the level of injury, ischemia time, history of diabetes, age, sex, and smoking history. During the replantation procedure, bone stabilization, tendon repair, arterial anastomoses, venous anastomoses, nerve coaptation, and skin coverage should be performed. All structures should be repaired primarily, unless a large nerve gap or a flexor tendon avulsion injury is present. Adequate postoperative evaluation is mandatory to avoid early or late complications. To improve functional results, many replantation patients may need further reconstructive surgery.
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            Finger replantation: surgical technique and indications.

            S Barbary, F Dap, G Dautel (2013)
            In this article, we discuss the surgical technique of finger replantation in detail, distinguishing particularities of technique in cases of thumb amputation, children fingertip replantation, ring finger avulsion, and very distal replantations. We emphasize the principles of bone shortening, the spare part concept, the special importance of nerve sutures and the use of vein graft in case of avulsion or crushing. However, even if finger replantation is now a routine procedure, a clear distinction should be made between revascularization and functional success. The indications for finger replantation are then detailed in the second part of this paper. The absolute indications for replantation are thumb, multiple fingers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Fingertip amputations distal to the insertion of the Flexor digitorum superficialis (FDS) are also a good indication. Other cases are more controversial because of the poor functional outcome, especially for the index finger, which is often functionally excluded.
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              Salvage of the mutilated upper extremity with temporary ectopic implantation of the undamaged part.

              M Godina, J Bajec, A BARAGA (1986)
              A method of salvage of mutilated extremities with temporary ectopic implantation of the undamaged distal part is described. We suggest that this method is indicated in devastating segmental injuries of extremities, where the distal part is devascularized and where a necessary radical debridement would include the structures which are indispensable for a good functional result of the replantation but which would possibly survive if treated with an open-wound technique. The method could also be used in cases where an essential length of limb could be preserved by open-wound management with improvement of the functional and aesthetic result of replantation. The method is contraindicated in injuries where perfusion of the distal part is preserved. The lateral upper part of the thorax is suggested as a convenient site, with the thoracodorsal artery and vein as recipient vessels. The timing of replantation of the ectopic implanted part must be carefully planned to avoid complications caused by remaining necrotic tissues or infection. The importance of intensive physiotherapy of the ectopic implanted part is stressed.
              Article 0 comments Cited 10 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Reports Plast Surg Hand Surg
                Journal ID (iso-abbrev): Case Reports Plast Surg Hand Surg
                Title: Case Reports in Plastic Surgery & Hand Surgery
                Publisher: Taylor & Francis
                ISSN (Electronic): 2332-0885
                Publication date (Electronic, pub): 21 May 2024
                Publication date (Electronic, collection): 2024
                Publication date PMC-release: 21 May 2024
                Volume: 11
                Issue: 1
                Electronic Location Identifier: 2350471
                Affiliations
                [a ]Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA, USA
                [b ]Department of Orthopaedics – Hand, Upper Extremity, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA, USA
                Author notes
                CONTACT Arriyan S. Dowlatshahi adowlats@ 123456bidmc.harvard.edu Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , 330 Brookline Avenue, Shapiro 2, Boston, MA 02215, USA
                Article
                Publisher ID: 2350471
                DOI: 10.1080/23320885.2024.2350471
                PMC ID: 11110872
                PubMed ID: 38778864
                SO-VID: 4187dc3f-4a3c-436f-a3f8-1dfa24406913
                Copyright © © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

                History
                Page count
                Figures: 6, Tables: 0, Pages: 8, Words: 3559
                Categories
                Subject: Case Report
                Subject: Case Report

                Keywords: hand replantation,digit replantation,microsurgery
                Data availability:
                Keywords: hand replantation, digit replantation, microsurgery

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