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Hand replantation

Dimitra Kotsougiani, Felicitas Ringwald, Caroline A Hundepool, Florian Neubrech, Thomas Kremer, Berthold Bickert, Ulrich Kneser, Christoph Hirche
Finger replantations demand technical excellence in microsurgery and hand trauma care. The objective of this study was to determine whether finger replantations constitute an appropriate and safe procedure for residency training. Additionally, the prognostic risk factors for the need to take a replanted finger back to the operation room and replant failure were analyzed.All patients who underwent finger replantation after complete amputation between 2007 and 2015 were included in a retrospective comparative study...
November 23, 2016: Annals of Plastic Surgery
Marília Pacífico Lucisano, Paulo Nelson-Filho, Lea Assed Bezerra Silva, Raquel Assed Bezerra Silva, Fabricio Kitazono de Carvalho, Alexandra Mussolino de Queiroz
The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed...
2016: Case Reports in Dentistry
Ileana Rodica Matei, Alexandru Valentin Georgescu
Amputation by crush injuries generally represents a contraindication for replantation, and especially when the lesion is caused by the summation of multiple concomitant traumatic mechanisms. We present the case of a 22 year- old female who arrived in our service with a crush/torsion amputation of all long fingers at the metacarpo-phalangeal level of the right hand. After the unsuccessful attempt of replantation, the functional reconstruction of the hand was achieved by using a double free flap transfer: anterolateral thigh perforator flap (ALT) and digital block transfer of second and third toes...
2016: Clujul Medical (1957)
Luis Landin, Pedro Bolado, Maria-Angeles Gajete, Alvaro Gonzalez-Miranda, Jorge Bonastre
Secondary surgical procedures can improve the function of revascularised and replanted digits. We describe the case of a patient who underwent multidigit revascularisation and replantation following a saw injury at flexor tendon Zone II. To achieve maximal functional improvement after finger revascularisation, we performed secondary surgical procedures in an order that was determined by following a reconstructive decision procedure that covered late revascularisation, nerve reconstruction, pedicled vascularised joint transfer, staged flexor tendon reconstruction and skin revision...
May 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Mohammed El Idrissi, Abdelhalim Elibrahimi, Mohammed Shimi, Abdelmajid Elmrini
Digital amputations are frequent injuries, the majority of them are caused by workplace accidents. Microsurgical techniques are an alternative option to repair these amputations. This study aims to report our experience in digital replantation through the examination of 18 cases. We conducted a retrospective study of 14 patients with total or subtotal fingers amputation between June 2013 and January 2015. All unidigital and multidigital replantations downstream of the distal insertion of superficial flexor tendon as well as all digital replantations upstream of the distal insertion of superficial flexor tendon were included in our study...
2016: Pan African Medical Journal
Zhenglin Chi, Peng Yang, Dajiang Song, Zan Li, Liang Tang, Weiyang Gao, Yonghuan Song, Tingang Chu
INTRODUCTION: To investigate the results of resurfacing completely degloved digits using bilobed innervated radial artery superficial palmar branch (RASPB) perforator flap in a spiral fashion. METHODS: A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The flap-raising procedure was performed using four fresh cadaver specimen...
October 21, 2016: Surgical and Radiologic Anatomy: SRA
Guangliang Zhang, Jihui Ju, Guangzhe Jin, Linfeng Tang, Yi Fu, Ruixing Hou
PURPOSE: The purpose of this study was to explore effective strategies of replantation or revascularization for the treatment of hand degloving injuries. METHODS: Ten patients who had received replantation or revascularization surgery for hand degloving injury between 2002 and 2014 were included for this study. The average age at the time of surgery was 34.5 years (range 18-49 years). There were nine left and one right hand replantations. The cause of injury was an industrial machine press in all of them...
September 19, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
David Graham, Praveen Bhardwaj, S Raja Sabapathy
The thumb plays an integral role in hand function. Traumatic amputation results in significant morbidity. With loss of the thumb, up to a 40% reduction in hand function may result. Thumb replantation must be attempted when possible. The goals of thumb reconstruction are to replicate normal function as closely as possible, minimize donor site morbidity, and expedite recovery. In the setting of a mutilated hand, the status of the remaining digits must be carefully assessed. Toe transfers, osteoplastic thumb reconstruction, and pollicization are commonly used...
November 2016: Hand Clinics
Sang Hyun Cho, Ahmed Suparno Bahar-Moni, Hyun Chul Park
The thumb is the most important part of the hand. If thumb is amputated, all efforts should be made to replant it to preserve hand functions. Good functional outcome can be obtained with successful thumb replantation than with other reconstructive surgery. We present a case of thumb amputation of a 44 -year-old male with severe damage to the soft tissues and bony structures of the radial part of the hand. We performed the replantation anastomosing the superficial palmar branch of the radial artery as donor artery as the proximal part of thumb digital arteries were severely damaged due to crush injury and got favorable result...
August 2016: Journal of Hand and Microsurgery
W Jeffrey Grantham, Philip To, Jeffry T Watson, Jeremy Brywczynski, Donald H Lee
INTRODUCTION: Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. MATERIALS AND METHODS: Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed...
August 2016: Journal of Hand and Microsurgery
Sang-Hyun Woo, Myung-Jae Yoo, Jung-Wook Paeng
Toe-to-hand transfer is the last option for definitive reconstruction of the hand when digits have been lost as a result of traumatic amputations, congenital anomalies, or tumor ablation. Immediate toe-to-hand transfer for the treatment of acute hand injuries is defined as an emergency operation performed when replantation is impossible or failed. The aim of this article is to propose the indications, advantages and disadvantages of immediate toe to hand transfer as well as to compare the overall results with elective cases...
October 2016: Journal of Hand Surgery Asian-Pacific Volume
Yong Seok Nam, Young Joon Jun, In-Beom Kim, Sung Hun Cho, Hyun Ho Han
Background There are a few previous studies of the vascular anatomy of the fingertips. The aim of this study was to evaluate this anatomy and the distribution of fingertip arteries. Patients and Methods A total of 31 cadaveric hands were used for evaluation of the vascular pattern of the fingertips on X-ray images obtained using a radiopaque material. We analyze the anatomy of the fingertip arteries, and classified it into three types in Tamai zone I. If only one dominant artery branched off from the distal transverse palmar arch, it was classified as type I...
September 5, 2016: Journal of Reconstructive Microsurgery
Mehmet Dadaci, Bilsev Ince, Zeynep Altuntas, Ozan Bitik, Haldun Onuralp Kamburoglu, Hakan Uzun
BACKGROUND: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. MATERIALS AND METHODS: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications...
July 2016: Indian Journal of Orthopaedics
Marie F A Cutiongco, Marek Kukumberg, Jonnathan L Peneyra, Matthew S Yeo, Jia Y Yao, Abdul Jalil Rufaihah, Catherine Le Visage, Jackie Pei Ho, Evelyn K F Yim
Microvascular surgery is becoming a prevalent surgical practice. Replantation, hand reconstruction, orthopedic, and free tissue transfer procedures all rely on microvascular surgery for the repair of venous and arterial defects at the millimeter and submillimeter levels. Often, a vascular graft is required for the procedure as a means to bridge the gap between native arteries. While autologous vessels are desired for their bioactivity and non-thrombogenicity, the tedious harvest process, lack of availability, and caliber or mechanical mismatch contribute to graft failure...
2016: Frontiers in Bioengineering and Biotechnology
Jun Yong Lee, Hak Soo Kim, Sang Taek Heo, Ho Kwon, Sung-No Jung
Replantation is a prime indication for distal digital amputation, as it helps restore hand aesthetics and functions; however, venous anastomosis is often not feasible. Previous studies used systemic anticoagulation in distal digital artery only anastomosis replantation surgery to improve replantation success rate, however, which yielded limited level of clinical evidence. This study aimed to compare controlled continuous heparinization (CCH) and intermittent bolus heparinization (IBH) for surgical outcome and clinical variables after single distal digital artery only anastomosis replantation surgery...
June 2016: Medicine (Baltimore)
Naoto F Ishikawa, Hiroyuki Togashi, Yoshiyazu Kato, Mayumi Yoshimura, Yukihiro Kohmatsu, Chikage Yoshimizu, Nanako O Ogawa, Nobuhito Ohte, Naoko Tokuchi, Naohiko Ohkouchi, Ichiro Tayasu
Long-term monitoring of ecosystem succession provides baseline data for conservation and management, as well as for understanding the dynamics of underlying biogeochemical processes. We examined the effects of deforestation and subsequent afforestation of a riparian forest of Japanese cedar (Cryptomeria japonica) on stable isotope ratios of carbon (δ¹³C) and nitrogen (δ¹⁵N) and natural abundances of radiocarbon (Δ¹⁴C) in stream biota in the Mt. Gomadan Experimental Forest and the Wakayama Forest Research Station, Kyoto University, central Japan...
May 2016: Ecology
S Dast, L Dessena, N Assaf, E David, C Herlin, R Sinna
Surgical treatment of complete cutaneous ring finger avulsion is a challenge in hand surgery. When replantation of the avulsed fragment is not technically feasible, the surgeon must consider reconstruction of soft tissue. Many surgical techniques have been described. We report a case of complete avulsion of the cutaneous sheath and nail of the fourth finger with preservation of mobility and collateral nerves. The reconstruction of soft tissue was performed by a Colson flap-graft. This simple and reliable technique of reconstruction allowed to obtain a functional and sensitive finger with a satisfactory cosmetic result...
June 22, 2016: Annales de Chirurgie Plastique et Esthétique
Christian T Bonde, Lisa Toft Jensen, Tina Tos, Birgitte Jul Kiil, Gete Ester Toft, Søren Erik Larsen, Peter Birkeland, Jens Ahm Sørensen
Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s. Microsurgery in hand surgery is primarily replantation and revascularisation but also peripheral nerve surgery as well as brachial plexus surgery. Lymphoedema is being treated with super microsurgery on an experimental basis. Dynamic reconstruction of facial palsy is performed in a two-stage operation with cross-over nerve graft and a free microvascular muscle flap, typically gracilis...
June 6, 2016: Ugeskrift for Laeger
Libing Chai, Hongxia Liu, Yuejiao Liu, Laijin Lu, Jianli Cui
OBJECTIVE: To investigate the decompression and diverting effects of vascular anastomosis based on the digital arterial arch branch in replantation of free finger-pulp in distal phalanges. METHODS: A retrospective analysis was performed on the clinical data of 12 patients (12 fingers) who underwent free finger-pulp replantation with anastomosis of proper palmar digital artery and the palmar digital artery arch branch in the distal end between December 2004 and March 2015...
February 2016: Chinese Journal of Reparative and Reconstructive Surgery
Komla Sena Amouzou, Komla Amakoutou, Batarabadja Bakriga, Anani Abalo, Assang Dossim
Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chen's criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country...
January 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
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