Hand replantation following three-level amputation: A case report

Abstract

This report of a successful wrist replantation after a 54-hour period of cold ischemia illustrates a number of interesting challenges in both the initial and late phases of treatment. Early problems include the prolonged ischemia time and soft tissue defects. Late problems include wrist instability, thumb stance, combined low nerve lesions, and the loss of intrinsic muscle tissue. A number of case reports and series have reported successful replantation after prolonged periods of ischemia. The value of immediate and appropriate tissue cooling in prolonged tissue survival is well established. However, the acceptable range of normothermic and hypothermic ischemic storage remains controversial. There is little question that the tolerance of composite tissue for ischemia is dependent on the quantity of contained skeletal muscle.’ Digit replantation has been reported after a hypothermic ischemic interval as long as 94 hours.’ Experimentally, successful revascularization has been carried out with anoxic periods exceeding 100 hours. We are aware of successful replantation of major human limbs with ischemic times of up to 13% hours3 and of successful human hand replantation after anoxic intervals of 7 hours4 and 36 hours.” We believe this case documents the longest anoxic period yet reported for successful hand replantation. We further believe that the functional result attained confirms the value of hand replantation even after such a prolonged ischemic interval.