Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 31:
Replantation Surgery
 
  Replantation was performed for complete hand amputation through the wrist.

FIG. 31-55. Amputated hand.


FIG. 31-56. The x ray reveals the level of amputation, through the distal radius and ulna.


FIG. 31-57. The amputated hand is explored and volar structures identified.


FIG. 31-58. Dorsal structures are identified and tagged.


FIG. 31-59. A T-plate is used to restore radial bone continuity, preserving wrist motion.


FIG. 31-60. X ray.


FIG. 31-61. Early postoperative result. A split-thickness skin graft was applied to the volar wrist to permit wound closure without tension.


FIG. 31-62. Postoperative function, extension.


FIG. 31-63. Flexion.


FIG. 31-64. Lateral view.


CASE 13

This case involved complete sharp amputation of the dominant hand in a 22-year-old man.

 

FIG. 31-65. The amputation was through the distal radius and ulna.


FIG. 31-66. Immediately after replantation. Volar view.


FIG. 31-67. Dorsal view.


FIG. 31-68. Late postoperative view, extension.


FIG. 31-69. Pinch. Individual finger flexion.


FIG. 31-70. Small grasp.


FIG. 31-71. Large grasp.


CASE 14

A patient sustained an avulsive hand injury. From Holl, E.J., and Buncke, H.J.: Microsurgical techniques to reconstruct irreparable nerve loss. Orthop. Clin North Am 12:381, 1981.

FIG. 31-72. In this avulsive hand injury, all tendons that cross the wrist were carried with the amputated part.


FIG. 31-73. The avulsed structures have been debrided, and the hand replated with Steinmann pins.


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