Transmetacarpal replantation: a case report

Dražan Erić; Maksim Kovačević; Milivoje  Dostić; Sanja  Djordjević-Marić; Siniša Kojić; Slobodan Kapor; Milomir  Ninković

doi:10.2298/VSP240112044E

Dražan Erić Al Emadi Hospital, Department of Plastic and Reconstructive Surgery, Doha, Qatar
Maksim Kovačević University of East Sarajevo, Faculty of Medicine, Foča, Bosnia and Herzegovina
Milivoje Dostić University of East Sarajevo, Faculty of Medicine, Foča, Bosnia and Herzegovina
Sanja Djordjević-Marić University of East Sarajevo, Faculty of Medicine, Foča, Bosnia and Herzegovina
Siniša Kojić Special Hospital for Plastic, Reconstructive, and Aesthetic Surgery – Varis Clinic, Belgrade, Serbia
Slobodan Kapor University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia
Milomir Ninković International Medical Center Priora, Department of Plastic and Reconstructive Surgery, Čepin, Croatia

DOI: https://doi.org/10.2298/VSP240112044E

Keywords: amputation, traumatic;, hand injuries;, metacarpal bones;, plastic surgery procedures;, quality of life;, replantation

Abstract

Introduction. Transmetacarpal amputation (TA) distal to the superficial palmar arch is one of the most difficult procedures in replantation surgery because it requires the reconstruction of blood vessels, muscles, tendons, bones, nerves, and skin. We present a case of a patient with TA of the left hand and microsurgical replantation. Case report. A 23-year-old left-hand dominant male worker with a positive smoking history sustained TA from a radial saw blade and avulsion injury of the palmar side of the thumb with no other apparent injuries. The time between the amputation and replantation was 4 hrs. The patient sustained the amputation at the level of metacarpophalangeal joints. The successful replantation included: wound and intrinsic muscles debridement, microvascular anastomoses of the blood vessels, internal fixation of the metacarpal bones, neurorrhaphy, tenorrhaphy, and wound closure with local skin flap for thumb soft tissue defect. The patient was followed for seven years postoperatively. Conclusion. The replantation surgery requires a specialized department and well-educated teams of hand microsurgeons, orthopedic surgeons, and anesthesiologists. The most important factors that influenced the outcome after the replantation in the presented case included the type and level of injury, ischemia time, comorbidities, age, smoking history, and physical therapy.

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