Reattachment of hand & arm. Follow-up result 9-years after amputation & replantation скачать в хорошем качестве

Reattachment of hand & arm. Follow-up result 9-years after amputation & replantation

Arm & hand transplantation can be offered to amputees. Replantation can be attempted after injury to achieve an optimal function. This video presents a case of a complete crush amputation at the above elbow level. The patient was admitted 4 hours after a motor vehicle collision. The avulsion crush injury involved skin, bone, tendon, nerve, and vascular defects. The reattachment procedure involved repair of all functional structures under general anesthesia. Following debridement and bone shortening metal plate osteosynthesis of the humerus shaft was performed. Vascular anastomoses of the brachial artery and two veins were done under a microscope. Avulsed tendons of the biceps and triceps muscles were reimplanted into their muscle bellies. Median, ulnar, radial, and medial antebrachial cutaneous nerves were sutured. The ulnar nerve was transposed anteriorly to avoid tension at the repair site. Closed forearm fasciotomy was preformed to prevent compartment syndrome. The procedure lasted almost 5 hours. The total warm and cold ischemia time was appr. 7,5 hours. Postoperatively, the elbow was immobilized in up to 90º of flexion to reduce the tension on the nerve anastomoses. Surgeon-controlled active and passive motion of the elbow was started at 4 weeks. To encourage nerve regeneration voluntary early exercises were advised for the paralyzed muscles. To prevent stretch injury to the nerve anastomoses full extension at the elbow was achieved gradually during the fist 3-4 postoperative months. Dynamic adhesive first web space splint to support recovery of the thumb extension and abduction was used. Static splints keeping PIP joints in extension were employed to facilitate intrinsic muscle function. Hand assessment demonstrated useful functions of the replanted limb at 9-year follow-up. The replant remained cold sensitive. Reasonable sensory and motor function was achieved. This was evident from 8 to 10-mm static two point discrimination, fair to good results of Moberg pick- up test and an object recognition test, recovery of extrinsic and intrinsic muscles, and good essential hand motion. However, the previous non-dominant right hand has spontaneously re-educated into the new dominant one. Replantation was performed by Valdas Macionis, M.D., Plastic and Reconstructive Surgeon, at Vilnius University Hospital, Vilnius, Lithuania. Conclusion: Tension free meticulous nerve repair and postoperative individual exercises are crucial for functional recovery after major limb replantation. References Malt RA, McKhann C. Replantation of severed arms. JAMA. 1964, 189:716-22. Mattiassich G, Rittenschober F, Dorninger L, et al. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskeletal Disorders. 2017;18:77. doi:10.1186/s12891-017-1442-3. https://www.ncbi.nlm.nih.gov/pmc/arti... Ng WK, Kaur MN, Thoma A. Long-term outcomes of major upper extremity replantations. Plastic Surgery. 2014;22:9-13. https://www.ncbi.nlm.nih.gov/pmc/arti... Gulgonen A, Ozer K. Long-term results of major upper extremity replantations. Journal of Hand Surgery Eur Vol. 2012 Mar;37:225-32. Laing TA, Cassell O, O'Donovan D, Eadie P. Long term functional results from major limb replantations. Journal of Plastic Reconstructive and Aesthetic Surgery. 2012, 65:931-4. Daoutis NK, Gerostathopoulos N, Efstathopoulos D, Misitzis D, Bouchlis G, Anagnostou S. Major amputation of the upper extremity. Functional results after replantation/revascularization in 47 cases. Acta Orthopaedica Scandinavica Suppl. 1995, 264:7-8. Graham B, Adkins P, Tsai TM, Firrell J, Breidenbach WC. Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study. Journal of Hand Surgery Am. 1998, 23:783-91 UCLA Hand Transplant Procedure. UCLA Health. Youtube video, published on 19 Oct 2011    • UCLA Hand Transplant Procedure