Rehabilitation of a patient following hand replantation after near-complete distal forearm amputation

Functional outcome of paediatric hand reimplantation with parents assisted physiotherapy during Covid 19 pandemic: Case report

An amputated hand in a child is considered an absolute indication for re-implantation. A key contributor to good functional outcome is the level of amputation, type of injury, warm ischemic time as well hand rehabilitation services. The role of parents in rehabilitation services has not been well defined. In our case report, we share the functional outcome of a six year old child that was successfully re-implanted followed by multiple sessions of physiotherapy during the Covid 19 pandemic period done by the parents. The functional outcomes for motor and sensory were closely comparable to the non-injured hand at one year of follow up. Parents should play an active role in rehabilitation of paediatric patients after re-implantation. They provide a supplementary approach to rehabilitation that could be cheaper and effective in ensuring good functional outcome.

Pediatric Replantation after Traumatic Amputation at the Distal Forearm: Rehabilitation Protocol and Outcomes

Major limb replantation is a formidable task, especially in the pediatric setting. While meticulous microsurgical technique is required in the operating room, the authors aim to highlight the importance of postoperative rehabilitation therapy for optimal function. We highlight the case of a 12-year-old boy who suffered complete traumatic amputation through the distal left forearm. The limb was successfully replanted with successful restoration of sensation and function with the aid of intensive postoperative occupational therapy. A multidisciplinary team is of paramount importance to maximize function of a replanted upper extremity.

Functional outcome using early controlled active motion in rehabilitation of a replanted hand: A case report

STUDY DESIGN

Case report.

INTRODUCTION

This case report details the postsurgical rehabilitation and outcome of a young maintenance man who sustained a complete amputation of his dominant upper limb at the level of the distal forearm. The patient underwent replantation surgery with 2-centimeter bone shortening, followed by early controlled active motion commencing on day 6.

PURPOSE OF THE STUDY

To illustrate the use of early motion after replantation.

RESULTS

The patient achieved almost full active range of motion of the digits, intrinsic function, 30 seconds on Nine-Hole Peg Test and early return to work without any additional reconstructive procedures.

DISCUSSION

Several fairly recently published protocols advocate initiating active range of motion at only 3 or 4 weeks after upper limb replantation. The following therapeutic interventions were considered important contributors to our favorable functional outcome; early controlled active motion, occupation-based therapy in combination with therapeutic exercises and many custom molded orthoses.

CONCLUSION

Future research is required to determine if bone shortening, which is an integral part of replantation surgery, reduces tendon repair tension, allowing for early active motion and thereby contributing to a favorable outcome.

Quantitative sensory testing after macroreplantation: evidence for a specific somatosensory profile

A comprehensive functional recovery is one of the criteria for successful replantation of an amputated limb. Functionality of a replanted limb is strongly dependent on its regained sensibility. In previous studies concerning the sensibility of replanted limbs, only a few somatosensory submodalities were examined in small samples. The purpose of this study is to provide a full pattern of somatosensory symptoms after replantation. Quantitative sensory testing was performed according to a standardized protocol in a sample of 15 patients who underwent replantation of their upper limb proximal to the radiocarpal joint (macroreplantation). Results indicate that most of these patients showed a specific somatosensory profile characterized by thermal and mechanical hypoesthesia and hyperalgesia in response to pressure pain, whereas no single case of hyperalgesia to heat pain occurred. This distinct profile of impaired somatosensation shares some features of the somatosensory profile of neuropathic pain syndromes. Patients' limbs that were replanted many years before the present quantitative sensory testing showed more sensory deficits than patients with more recent replantations. This knowledge might be helpful in the development of more specific and more successful rehabilitation programs with replanted patients and improves the behavioral function of the replanted limb.