Greater and More Natural Use of the Upper Limbs During Everyday Life by Former Amputees Versus Prosthesis Users

Hand loss profoundly impacts daily functioning. Reversal of amputation through hand replantation or transplantation offers an alternative to prosthetics for some. Whether recipients exhibit more extensive and natural limb use during everyday life than prosthesis users is, however, unknown. We asked unilateral, below-elbow amputees (N = 22), hand graft recipients (transplants N = 4; replants N = 2), and healthy matched controls (N = 20) to wear wireless accelerometers distally on their forearms/prostheses and proximally on their upper arms. These units captured limb activity over 3 days within participants’ natural environments. Graft recipients exhibited heavier reliance on their affected hands compared to amputees’ reliance on their prostheses, P < .001. Likewise, reliance on the injured side upper arm was also greater for hand graft recipients than amputees, regardless of whether they were wearing their prostheses, P < .05 in both cases. Hand graft recipients, like healthy controls, also relied more on forearm vs upper arm movements when controlling their limbs, P < .001. Compared with conventional prosthesis users, graft recipients exhibited more extensive and natural functioning of the upper limbs during everyday activities. This information is an important addition to other considerations when evaluating risk-benefit of these treatment alternatives.

Replantation fingertip without venous anastomoses in children

Objective. Traumatic complete and partial finger amputations are rare in comparison with adults. There are significant differences between mechanism of trauma, principles of treatment children with this type of injury in comparison with adults.Clinical case. A 15-years old child suffered from injury by axe, which caused the traumatic fingertip amputation of III and IV digits of his right hand. Replantation of both amputated parts was performed. Arteries and nerves were repaired with no veins anastomosed. As a result - survival of replanted parts.Discussion. A submillimeter diameter of vessels and potential venous congestion are basic problems that a surgeon deal with when perform the replantation of fingertips. Respectively, a difficulty in post-operative care of patient appears.Conclusion. Replantation of amputated part of finger is a golden standard of treatment of children with a described type of injury. The correct deliverance of amputated parts, the shortest time of ischemia as possible, a qualitive operation and post-operative care play an important role in successful survival of the replanted segments.

A serious complication after forearm replantation caused by a cord tightened on the stump during transportation – a case report

In amputations of an upper extremity, an adequate preservation of the amputated part during its transport to a replantation centre is very important: it needs to be maintained at about 4°C. Providing adequate haemostasis of the extremity stump is also important for the patient’s safety, to avoid bleeding on the journey. The article presents the case of a patient who had sustained a hand amputation at the forearm, in which bleeding from the stump was stopped with a cord that has been tightened on the forearm, 10 cm above the amputation site. Transport for the patient took over 6 h and resulted in a critical ischaemia ofthe forearm stump. Replantation was successfully performed, but an excessive oedema of the ischaemically injured part of the stump developed in the post-operative course, requiring a fasciotomy, resection of the necrotic muscles, following by coverage of the defects with skin grafts. No complications were observed in the replanted part of the forearm, and the prognosis towards recovery of good hand function is moderate, due to the loss of a portion of the forearm muscles.Keywords: hand replantation; postoperative complications; muscle ischaemia; malpractice.

Ectopic Banking and Implantation of an Amputated Hand

Background Ectopic banking includes techniques and indications used to bank amputated body parts for later replantation when a body part is amputated in its entirety. Immediate replantation is sometimes impossible due to hemodynamic instability, soft tissue loss, and extensive contamination of the amputated part. The first case of temporary ectopic banking of hand implantation was reported in 2015 by Xu Zhang in China which was not completely successful. The first replantation was reported almost 54 years ago, followed by a limited number of similar cases that were not successful. Xu could not restore the useful function of the replanted hand. Purpose In this study, we reported a case of hand replantation by the banking technique. Method We carried out a hand replantation by the banking technique using the right ankle as the recipient site. Result We restored the useful function of the amputated part and evaluated the function with standard tests. Conclusion Using right ankle as recipient site in ectopic banking can be a useful approach which helps and ensures the researchers and surgeons to decide if they intend to use this method.