FIG. 31-105. Amputated arm.

FIG. 31-106. Given the double-level nature of the injury, the ischemia time, and the age of the patient, replanting the arm to restore length and re-establish elbow flexion. Vein grafts were needed in the brachial artery and vein.

FIG. 31-107. Postoperatively, there is excellent elbow flexion.

FIG. 31-108. Extension.

FIG. 31-109. The patient can comfortably wear a below-elbow prosthesis, and has returned to work.

CASE 20

Total sharp foot amputation occurred in a 38-year-old man. This injury represents one of the few lower limb amputations that deserve consideration of replantation.

FIG. 31-110. Amputated foot.

FIG. 31-111. Placement of an external fixator.

FIG. 31-112. Revascularization.

FIG. 31-113. Late follow-up shows a closed, stable wound with no bone shortening.

FIG. 31-114

CASE 21

A 26-year-old man suffered a devascularizing injury to his foot after falling into an auger-driven well.

FIG. 31-115. Posterior view.

FIG. 31-116. Immediate temporary revascularization with a silastic T tube.

FIG. 31-117. The foot was successfully replanted, but the skin over the dorsomedial aspect of the angle sloughed. Proximal wound is another injury.

FIG. 31-118. Final wound closure was accomplished with the transplantation of a free serratus flap. Patient is now walking.

CASE 22

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