Summary
Introduction
Avulsion and crush injuries constitute a particularly difficult problem due to extensive
damage of vessels and nerves. In cases where a crush is the dominating injury factor
causing complex fractures of forearm and carpal bones, shortening of the extremity
is necessary for primary vessel and nerve reconstruction. Surgical experience in vessels
dissection and optimal sequence of reconstruction procedures using vessels and nerve
grafts are of paramount importance.
Material and methods
In the years 1986–2006 the author carried out 18 replantations and 4 revascularizations
at various levels of distal upper limb after crush-avulsion trauma. There were 8 thumb,
7 long fingers and 7 hand amputations. Hand replantations were carried out in 5 males
aged 18–45 (mean age 33). Thumb replantations were carried out in 2 females and 5
males. There were 4 complete amputations of a long finger (three teenagers and 32-year-old
male). A vein grafting from the forearm was the basic method used in arterial reconstructions
(3 hands, 5 thumbs and 6 long fingers). Grafts of the deep radial vein were used in
2 cases (one in hand and one in the thumb). Change in the standard sequence of the
replantation procedure (i.e. reconstruction of the artery on the ulnar side of the
thumb before bone stabilisation) appeared very helpful on thumb. Rerouting veins,
venous flaps or skin flaps from the dorsal surface of the index finger were very useful
in reconstruction of the blood outflow. Secondary reconstruction of nerves were carried
out in 8 patients (40%) and 5 patients are still waiting for the surgery.
Results
Sixteen out of 18 replants (88.9%) and all 4 revascularized parts survived. Overall
success rate was 90.9%.
Conclusions
Grafting technique in reconstruction of arteries and veins during the primary vessels
repair is a very good method and we advocate that it should be widely used. Due to
extent of trauma, majority of the patients required secondary procedures – mainly
reconstruction of nerves with nerve grafts.
Keywords
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Article info
Publication history
Published online: May 10, 2007
Accepted:
March 7,
2007
Received:
November 1,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
