Replantation of a Transmetacarpal Amputation

ABSTRACT

A case is presented of a 23-year-old male who sustained a traumatic transmetacarpal amputation of his nondominant hand. The injury consisted of complete severance of structures distal to the midpalm. Microsurgical reconstruction involved the primary repair of arteries, veins, nerves, extensor and flexor tendons, and metacarpal fractures. Skeletal reconstruction also employed a primary Swanson prosthesis for the fifth metacarpophalangeal (MP) joint. Early postoperative range-of-motion exercises were encouraged, with the achievement of a functionally capable replanted extremity. The general management of an amputation injury is also discussed, as it applies to a community hospital environment.

6 Editorial Note. This case report is being published to emphasize the growing number of surgeons becoming expert in microvascular techniques. The institution of a replantation team either in a university or community hospital requires more than technical competence. It requires the commitment of a number of dedicated surgeons to accept transfers requiring replantation surgery on a continual basis. Amputation injuries urgently require prompt care. Referring physicians must be able to expect rapid transfer to a replantation center at all times. Prompt attention by this community-based replantation team resulted in this admirable case report. B.S.