Forearm replantation after traumatic complete amputation

Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

OBJECTIVE

To examine the efficacy of three different nerve repair methods for one-stage replantation to treat complete upper extremity amputation and long-term postoperative functional recovery.

METHODS

Twenty-five patients underwent direct nerve anastomosis (Group A), for patients with nerve defects greater than 3 cm, nerve autograft transplantation be used (Group B), or patients with nerve defects less than 3 cm, nerve allograft transplantation be used (Group C) based on the severity of injury. The Disabilities of the Arm, Shoulder, and Hand (DASH) score (higher score means poorer function-less than 25 means good effect) and visual analogue scale (VAS) scores for pain at rest and under exertion were measured. Sensation recovery time and grip function were recorded.

RESULTS

The mean follow-up time was 78 ± 29 months. Group A had the lowest DASH score, while Group C had the highest DASH score. DASH score differed significantly between the three groups (P < 0.001). Sensation was not restored in two patients in Group B and two patients in Group C, and there were significant between-group differences in sensation recovery (P = 0.001). Group C had the lowest VAS score, while Group A had the highest, and there were significant differences between groups (P = 0.044). Only one patient in Group C recovered grip function.

CONCLUSION

Direct nerve anastomosis should be performed whenever possible in replantation surgery for complete upper extremity amputation, as the nerve function recovery after direct nerve anastomosis is better than that after nerve autograft transplantation or nerve allograft transplantation. Two-stage nerve autograft transplantation can be performed in patients who do not achieve functional recovery long after nerve allograft transplantation.

Replantation of amputation at the wrist: challenges of management in sub-Saharan Africa

Amputations of the upper limb, in particular, have a major impact on patients' lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.