Late hand replantation with restoration of intrinsic muscle function: a case and review of the literature

We report the case of a traumatic trans-carpal hand amputation in a 40-year-old male, with a second-level injury more distally at the metacarpal heads, who was replanted with a total ischaemic time of 19 h and 25 min. The decision was made to retain his intrinsic hand muscles in contradiction to common practice. At 2.5 years follow-up, he has regained a remarkable level of function of his hand including activation of his intrinsic hand muscles. His Semmes Weinstein testing has also sho wn good sensory recovery of his repaired nerves and he enjoys little, if any, disability as a result of his injury (despite a double-level injury on the dorsal ulna aspect of his forearm). This suggests, in cases of hand amputation with appropriate hypothermic transportation of the amputated part, i schaemia times up to 20 h may be compatible with restoration of intrinsic hand function.Level of Evidence: Level V, risk / prognostic study.
Source: European Journal of Plastic Surgery - Category: Cosmetic Surgery Source Type: research