FIG. 32-19

FIG. 32-20. Replantation of the hand was performed with intramedullary K-wires driven into the carpal bones, leaving the radiocarpal joint free.

FIG. 32-21. Solid fixation was obtained, allowing rapid revascularization of the amputated part. Wrist and joint motion has been restored with aggressive physical therapy. Tendon grafting and a toe-to-hand transfer for the nonreplantable thumb are planned.

CASE 6

A 21-year-old woman suffered a transmetacarpal amputation of her nondominant left hand while at work in a yarn factory. The thumb was spared without fracture.

FIG. 32-22. Sharp transection of all structures was found in the distal amputated part.

FIG. 32-23. The preoperative x ray shows an intact thumb and basilar joint with sharp transection across the remaining metacarpals.

FIG. 32-24. Replantation was performed using the small plate fixation set, with 1.2 cm screws and four-to-five-hole plates.

FIG. 32-25. The oblique x ray shows the volar contact necessary for rigid fixation. Care must be taken to limit impingement on gliding structures within the palm.

FIG. 32-26. Lateral x ray.

CASE 7

A patient suffered complete hand amputation through the distal carpal row.

FIG. 32-27. Preoperative appearance.

FIG. 32-28. Replantation was performed with wire fixation into the proximal carpal row. The ring tip was not replantable.

CASE 8

A 27-year-old man destroyed the metacarpal arch of his dominant hand in an industrial engine. The wound was severely contaminated and required multiple debridements. To maintain the metacarpal length and allow wound access, a mini-Hoffman external fixator was applied.

FIG. 32-29. A lateral view of the fixator demonstrates the extensive soft and bony tissue loss.

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