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PubMed1982

Traumatic amputations and the need for a replantation service in Finland.

The authors review a series of 290 upper extremity amputee patients injured between 1974-79 from a 400,000 population area of one central hospital. Among these amputation injuries were 55 cases which were considered "serious", i.e. effecting seriously the function of the hand. Calculations were extrapolated to obtain reliable numbers for the need of a replantation service in Finland within a population of 5 million. According to the available data 90-160 patients annually would need a replantation service for their amputation injuries inthe country. Some conclusions were also drawn about the results obtained with or without replantation surgery among the "seriously injured" group. The results obtained with the replantation service were clearly superior to the results achieved without replantation.

Adolescent↗
PubMed1982

[Thumb replantation: results of avulsion injuries and other traumatic amputations--a comparison].

In Tampere Central Hospital, Finland, 30 thumb replantations or revascularisations were carried out between March 1977 and March 1980. 22 were complete amputations and 8 were incomplete severances. Half of this material was due to avulsion injury and the other half consisted of local crush or sharp cut injuries. Ten cases in each group were considered equal and functional comparison was possible. Some technical points in replanting avulsed thumbs are presented. In particular the reconstruction of the flexor pollicis longus tendon and muscle is described. The avulsed flexor tendon was rerouted and refixed to its own torn muscle remnants in 11 of 12 cases with totally avulsed tendon. The results show that by abundant use of free veingrafts (in 80% of cases) the survival rate with avulsion injury can be almost as high as with local crush or more sharp injuries. Three thumbs were lost--two in the avulsion group--giving an overall primary survival of 90%, avulsion 87%, local crush 93%. Functional results show after 9 to 36 months follow-up time (mean 21 months +/- 8) that sensory recovery is superior after local crush compared with replantations after avulsion injury. Otherwise the differences are small and a useful end result can be obtained in most avulsion cases. 80% of the patients returned to their original work within the first six months (four months mean). Avulsion injury of the thumb, which is rather common among people working with fast rotating axles, seems to be an important indication for replantation surgery although more painstaking work is needed to obtain a favourable end result.

Amputation, Traumatic↗
PubMed1982

Lengthening of the fingers after traumatic amputation.

Ten cases with lengthening of one of the fingers (as opposed to the thumb) are reported out of which nine were lengthened at the proximal phalanx and one at the middle. A small distraction device has been utilized, based on the principle of Ilizarov's apparatus with some alterations necessitated by the small size and specific requirements of the hand. The lengthening achieved varies from 1.2 to 3.2 cm, and after it has been accomplished, osteoplasty with bone graft has been performed in all cases. The results obtained are considered to be good both from the functional and the cosmetic point of view.

Amputation, Traumatic↗
PubMed1994

[Indications for replantation of lower limbs after their traumatic amputation at the shin level].

From analysis of the results of replantation of 37 lower limbs at the level of the leg, which were amputated as the result of injury in 33 patients, the authors determine the tactical approach to the choice of indications for replantation. The authors believe that replantation at the level of the leg is always indicated in children if it is executable technically and the patient's somatic status presents no general contraindications. In other cases the formation of a stump and subsequent prosthetics should be considered more advisable.

Adolescent↗
PubMed1996

Metacarpal lengthening after traumatic amputation of the thumb.

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal. The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment. Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.

Adult↗