Unusual case of successful hand replantation with bad functional outcome: A case report

Abstract

Introduction. Traumatic hand amputation is a very severe and rare injury. Replantation and revascularization surgery requires the existence of specialized centres and well-educated teams of microsurgeons. In places where there are no such specialized centres for this kind of surgery, traumatic hand amputation is a major concern and quite a challenge, and a successfully performed replantation is a great accomplishment. Case Outline. We report a case of a successfully survived replanted hand in a 35-year-old male patient with unfortunately bad end result of the treatment. The patient with the amputated left hand (disarticulation) had a surgery 4 hours after injury. The urgent surgical procedure required a debridement, the excision of the first row of the carpal bones, external fixation of the wrist, vascular anastomoses, nerve repair, tenorrhaphy, skin sutures and decompression skin incisions. The successful operation did not have a successful post-operative course due to the patient?s psychiatric problems and lack of rehabilitation at the psychiatric institution where the treatment was continued. Conclusion. Successful surgical performance can unfortunately be ruined due to inadequate further treatment course or the wrong selection for such a demanding surgery. The survival of the amputated hand can be achieved surgically, but achieving refunctioning does not always depend on surgery. It also depends on the very patient, his motivation, rehabilitation, as well as on the proper selection for such a demanding and complex surgical procedure.Uvod. Traumatska amputacija sake je vrlo retka i teska povreda. Replantaciono hirursko lecenje obavlja se u specijalizovanim centrima, a vrse ga dobro obuceni timovi mikrohirurga. Tamo gde ne postoje specijalizovani centri za ovakvu vrstu hirurgije traumatska amputacija sake je veliki problem i pravi izazov za lekara, a uspesno uradjena replantacija znacajan poduhvat. Prikaz bolesnika. Prikazujemo slucaj uspesnog prezivljavanja replantirane sake kod 35-godisnjeg bolesnika sa, nazalost, losim krajnjim funkcionalnim rezultatom. Bolesnik s amputiranom sakom (dezartikulacija) operisan je cetiri sata posle povredjivanja. Hitna hirurska intervencija podrazumevala je ciscenje rane, eksciziju prvog reda kostiju karpusa, spoljasnju skeletnu fiksaciju rucnog zgloba, usivanje arterija, vena, nerava, tetiva i koze i dekompresione incizije. Uspesna visecasovna operacija bila je ugrozena tokom postoperacionog toka zbog psihickog oboljenja bolesnika i izostanka rehabilitacije u psihijatrijskoj ustanovi u kojoj je lecen. Zakljucak. Odlican hirurski rad, nazalost, moze se ugroziti neadekvatnim nastavkom lecenja ili pogresno postavljenom indikacijom za ovako zahtevnu operaciju. Prezivljavanje amputirane sake postize se operacijom, ali ponovno uspostavljanje njene funkcije ne zavisi samo od hirurskog rada, vec i od samog bolesnika, njegove motivisanosti, toka oporavka, odnosno pravilno postavljene indikacije za ovako slozen i tezak hirurski zahvat. PR Projekat Ministarstva nauke Republike Srbije, br. III41017: Virtuelni humani kostanozglobni sistem i njegova primena u pretklinickoj i klinickoj praksi