[Late results following avulsion injuries of the thumb]

Hand Replantations Following Complete Amputations at the Wrist Joint: First Experiences in Hanoi, Vietnam

Five completely amputated hands at the level of the wrist joint were replanted. The five patients were all men, ranging from 19 to 31 years and the amputations were all the result of knife injuries. All the revascularizations were successful. Secondary tenolysis was required in one case. Postoperative functional results compared to the uninjured hand were evaluated according to five main criteria: (1) the patient’s overall satisfaction with the hand; (2) recovery of flexor and extensor function of the thumb and fingers; (3) recovery of thumb opposition; (4) recovery of sensitivity in the median and ulnar nerve distributions; (5) ability of the surviving hand to perform daily tasks. The results showed that, although the replanted hands were never functionally as good as the contralateral hand, the patients were able to use them satisfactorily for activities of daily living. Our results demonstrate that replantation following complete amputation at the wrist joint level as a result of a sharp injury is extremely worthwhile and has excellent potential for functional recovery.

Limb replantation after avulsion injuries: techniques and tactics for success

Objectives

Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results.

Methods

Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries.

Results

The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction.

Conclusion

Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.

[Microsurgical thumb replantation following traumatic amputation: preliminary results in Hanoi, Vietnam]

INTRODUCTION

Replantation using microsurgical techniques is a fairly new procedure in Vietnam. We reviewed and evaluated our 7-year results of thumb replantation in Vietnamese patients following traumatic thumb amputation.

MATERIAL AND METHODS

Traumatic thumb amputations between September 1999 and July 2006 were reexamined and evaluated. Postoperative functional results were evaluated based on four main criteria: 1) the patient's subjective attitude regarding the replanted thumb, 2) the degree of mobility of the replanted thumb compared with its counterpart, 3) the level of sensitivity of the replanted thumb, and 4) the objective ability to perform daily tasks.

RESULTS

A total of 26 patients were documented. The duration of follow-up averaged 22 months (range 6-72 months). The success rate of replantation was 81%. A rating of either "good" or "very good" was obtained for 81% of the replanted thumbs.

DISCUSSION

Vascular thrombosis was the cause of all failures. Proper debridement, standardized microvascular techniques, timely detection of thrombosis formation, and reoperation using vein grafts play a decisive role in the final success.