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Reconstructive surgery to attach a severed hand!

Reconstructive surgery to attach a severed hand!

This is a middle-aged male with an amputation at the level of the distal forearm who underwent replantation and successful salvage of his hand.

An amputation of the hand is a devastating injury. It adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities.

Replantation is defined as the reattachment of the amputated limb using the neurovascular and musculoskeletal structures in order to obtain recovery of the limb.

The simple return of circulation to the distal part does not in itself define success. The technical steps involved include examination and dissection of the neurovascular structures, bone fixation, tendon and muscle repair followed by microsurgical artery, nerve and vein repair, and finally skin closure. The hand is placed in a splint and the patient is monitored closely for circulatory changes in the fingers during the post-operative period.

The decision to attempt salvage in such an injury has evolved and is influenced by many factors, including the importance of the part, level of injury, expected return of function, and mechanism of injury. The absolute contraindication to attempting salvage is the existence of associated injuries or preexisting illnesses which may preclude transfer or a prolonged operation. Relative contraindications include vascular/nerve injuries at multiple levels and patients who are mentally unstable. Success rates are expected to be poor when there is a crush/avulsion injury as compared with a guillotine type of injury.


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