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Forearm re-implantation after traumatic complete amputation in Apollo Hospitals

A19 yr old farmer presented to Orthopedic department, Apollo Secunderabad with complete amputation of the right forearm. His right arm had been caught between the crop cutting machine. He was transported to Apollo Secunderabad from Gajwel(60 km away) within 1 hr 50 minutes of the accident. He was advised to carry the amputated forearm in a clean saline soaked cloth by Orthopedic surgeon Dr Kiran K Reddy.

He was taken into the operating room immediately. It was a crush amputation at upper third and the middle third junction with contamination. Under antibiotic coverage thorough wound debridement was done. Bone fixation with plates, single artery anastomosis, dual vein anastomosis, median and ulnar nerve repair, soft tissue repair over VAC was done.

Immediately after surgery, he maintained good perfusion without any reperfusion syndrome. He was discharged on 5th day after debridement and VAC dressing. Subsequently, he was taken for debridement twice on day 10, 15 with daycare admission. At the end of 3 weeks, healthy red granulation tissue was noticed, skin grafting was done with VAC dressing.

Postoperative day 1, he was given aggressive physiotherapy of elbow and shoulder. At the end of 6 weeks, the wound was completely healed, the range of movement of the elbow, gradually improved. At postoperative 4months, the function of the shoulder and elbow regained completely. The distal sensation was near normal. Wrist and hand had reasonable movements. Despite the poor functional ability of hand, the patient was quite satisfied and appreciative. He was able to hold the smartphone with the amputated hand.

Limb amputation cause loss of physical integrity and also affect an individual’s mental and social wellbeing and is a significant problem, especially for younger people and the working population. Despite the significant progress of modern prosthetic devices, high rejection rates are still observed in most traumatic amputation patients. Hence, arm replantation is still believed to be superior to an amputation stump fitted with an appropriate prosthesis.

Learning points

1) Limb amputation has a profound impact on a patient’s quality of life and poses a burden on the social economy.
2) The long-term subjective functionality of replanted upper extremities is satisfactory for patients.

Dr. Kiran K Reddy Badam 
MS (AIIMS MCh (AIIMS), Ortho, Spine, Paeds Ortho surgeon. MS, DNB, MRCS
Edinburgh, FIJR(Depuy), FIPO(Singapore),
Consultant Orthopaedic Surgeon,
Apollo Hospitals, Secunderabad, Hyderabad, India.

Dr. M V Naveen Reddy
MBBS, MS General Surgery(Osmania), Mch Plastic Surgery (KEM Bombay),
Consultant Plastic & Cosmetic Surgeon,
Apollo Hospitals, Secunderabad, Hyderabad, India.

 

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