Complete arm amputation was seen in a 3-year-old boy. From Buncke H.J., and Valouri, F.A.: Digital and upper limb replantation, Chapter 87. In The Hand, Vol. III. Editor Tabiana Raal. Philadelphia, W.B. Saunders, 1988.

FIG. 31-91. The arm has been transected at the midshaft of the humerus.

FIG. 31-92. Amputated part.

FIG. 31-93. To reduce ischemia time during bone fixation, temporary shunts are placed into the arterial circulation and restore the ischemia time to zero.

FIG. 31-94. Plate fixation of the humerus before arterial and venous grafting.

FIG. 31-95. Early postoperative view.

FIG. 31-96. Destruction of the biceps has led to progressive flexion contracture of the elbow, and a prominent radial palsy.

FIG. 31-97. The pedicled latissimus muscle is again used to restore elbow flexion, reduce the contracture, and cover nerve grafts placed in the median and ulnar nerves. Flap on chest.

FIG. 31-98. Flap rotated around the medial arm, antecubital area and forearm.

FIG. 31-99. Four-year follow-up. Tendon transfers were performed to correct the radial palsy, after the forearm muscles were reinnervated through the nerve grafts.

FIG. 31-100. Useful sensation and function are restored to the extremity.

CASE 18

A patient sustained complete amputation of the arm just distal to the elbow.

FIG. 31-101. Without replantation, the forearm stump would have been too short to hold a below-elbow prosthesis.

FIG. 31-102. Dorsal view, with good elbow extension.

FIG. 31-103. This patient has had return of thumb opposition.

FIG. 31-104. Finger and elbow flexion are excellent.

CASE 19

A patient suffered a two-level injury, through the proximal humerus and wrist. All structures except a dorsal skin bridge were transected at the wrist.

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