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

Ključne reči: amputacija, traumatska;, šaka, povrede;, kosti, metakarpalne;, hirurgija, rekonstruktivna, procedure;, kvalitet života;, replantacija

Sažetak

Uvod. Transmetakarpalna amputacija (TA) distalno od površinskog dlanskog luka je jedna od najtežih procedura u replantacionoj hirurgiji jer zahteva rekonstrukciju krvnih sudova, mišića, tetiva, kostiju, nerava i kože. Prikazan je slučaj bolesnika sa TA leve šake i mikrohirurškom replantacijom. Prikaz bolesnika. Radnik star 23 godine, pušač, dominantno levoruk, zadobio je TA cirkularom i avulzionu povredu palmarne strane palca bez drugih, vidljivih povreda. Vreme između amputacije i replantacije iznosilo je 4 sata. Bolesnik je zadobio povredu, amputaciju u nivou metakarpofalangealnih zglobova. Uspešna replantacija je uključivala: debridman rane i intrizičnih mišića, mikrovaskularne anastomoze krvnih sudova, unutrašnju fiksaciju metakarpalnih kostiju, neurorafiju, tenorafiju i zatvaranje rane lokalnim kožnim režnjem za defekt mekog tkiva palca. Bolesnik je praćen sedam godina posle operacije. Zaključak. Replantaciona hirurgija zahteva specijalizovani centar i dobro obučen tim mikrohirurga šake, ortopedskih hirurga i anesteziologa. Najznačajniji faktori koji su kod prikazanog bolesnika uticali na rezultat posle replantacije bili su tip i nivo povrede, vreme ishemije, komorbiditeti, životno doba, anamneza pušenja i fizikalna terapija.

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Transmetakarpalna replantacija

Sažetak

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