Forearm Elongation After Hand Replantation

Abstract

T he cases of a considerable number of patients who have had successful hand and forearm replantation have been reported1-6. Success depends primarily on the surgical technique and the type of injury. Amputations with a narrow area of injury have the best expectations for a successful recovery7,8. Amputations with extensive areas of injury of the forearm, wrist, and hand, such as crush and avulsion injuries, reduce the chances of survival and functional recovery9,10. The objective of this case report was to demonstrate the possibility of restoring a functional upper extremity in a patient with a complete amputation of the hand at the level of the wrist with extensive damage to all of the tissues at the amputation level. I n October 2001, a thirty-four-year-old right-hand-dominant man was working with an agricultural machine that separates corn grains from corncobs (a corn sheller) when the machine stopped working. In order to remove the obstruction, he put his hand into the machine without turning it off. The rollers of the machine caught the left hand and forearm and completely amputated the hand at the level of the wrist. It took twenty minutes to turn off and dismantle the machine to release the injured man. He arrived at our hospital three hours after being injured. In preparation for the surgery, intravenous fluids and tetanus immunoglobulin were administered. As the accident had happened in the farmyard and the wound was characterized by extensive soft-tissue damage and contamination with parts of plants, soil, clothes, and machine oil, a combination of imipenem and cilastatin sodium was administered, by intravenous infusion, starting at the time of admission to the hospital. The amputated hand (Fig. 1) sustained considerable damage in the area of the wrist and the …