Successful Hand Replantation: After a Complete Amputation at Wrist Level
Introduction
Hand replantation, particularly at the wrist or forearm level, is an extremely rare, complex, and challenging surgery that requires immediate and expert medical intervention. Successful replantation of a severed hand is a highly skilled and complicated procedure, and success depends mainly on the timing of arrival since the injury, availability of expert microsurgeons, multi-disciplinary approach, and advanced hospital facilities like operating microscopes, supermicro instruments, and ability to perform micro-suturing techniques.
Case Presentation
A 21-year-old male sustained a traumatic complete amputation of his right hand at the wrist while working at his workplace. Patient arrived in the emergency department within 2 hours of injury. Due to the gravity of the injury, immediate emergency services were deployed. After initial stabilisation, the patient underwent a 10-hour hand replantation surgery performed by a team of specialised plastic and orthopaedic surgeons along with anaesthetist and OT support staff.
Patient History
Ram Sevak was a healthy young male labourer. On the day of the incident, he was working at an industrial site when his right hand was completely severed at the forearm level by a heavy sheet of metal. Patient arrived within 2 hours with amputated hand preserved in ideal cold storage condition. The patient was examined and emergency resuscitation was initiated.Â
Diagnostic Assessment
Upon arrival at the hospital, basic blood tests and x-rays were done.
Treatment Approach
The patient was immediately taken to an emergency operation theatre, and the staff were immediately pressed to action within 3 hours of injury. A multidisciplinary surgical team, including Dr. Jammula S. Srinivas (plastic surgeon), Dr. Brijesh Kidiyoor (orthopaedic surgeon), and Dr. Prateek (anaesthesia), along with other team members, was assembled. After obtaining informed consent from the patient and family, the surgery was started. The replantation surgery lasted for 10 hours from 8 P.M to 6 A.MÂ and involved several complex
- Bone Fixation: Both bones of the forearm were shortened by 7 cm, and internal plating was performed.
- Vascular Repair: Two arteries and four veins (two superficial and two deep) were meticulously repaired to restore blood flow to the amputated hand.
- Nerve Repair: Two major nerves were repaired to facilitate the return of motor and sensory functions.
- Tendon and Skin Repair: Around two dozen tendons were repaired, and the skin was sutured.
- Blood Transfusions: The patient required two blood transfusions during the procedure.
- Postoperative Care: The patient was closely monitored in the ICU to ensure the viability of the replanted hand.
Outcome
The patient recovered smoothly postoperatively, with the replanted hand showing signs of survival. After the surgery, slight finger movement was observed, which means that the patient is responding positively to the treatment. The patient will require follow-up visits and physiotherapy sessions to regain complete functionality and strength in his hand. The timely intervention and expert surgical skills led to the successful replantation of the hand, with the patient showing promising early signs of recovery.
Discussion
Hand amputations at the wrist or forearm level are extremely rare, occurring in approximately 1 in 30 lakh people. These injuries are commonly seen in industrial accidents or violent assaults. Replantation requires the immediate preservation of the amputated part, a rapid response team, and a hospital equipped with advanced microsurgical tools and experienced specialists. In this case, the prompt arrival of the patient to the hospital, the timely initiation of the surgery, and the re-establishment of blood supply within 8 hours were critical to the success of the procedure.
Microsurgical replantation involves the intricate repair of bones, blood vessels, nerves, tendons, and skin to restore both the structure and function of the severed limb. The success of such complex procedures depends not only on surgical expertise but also on supportive postoperative care and rehabilitation. In Ram Sevak’s case, the multidisciplinary approach and well-coordinated efforts among surgical, orthopaedic, anaesthesia, and nursing teams contributed to the positive outcome.
Conclusion
This case highlights the importance of timely intervention, surgical expertise, and advanced medical facilities in achieving successful outcomes in hand replantation surgeries. The patient’s recovery and early finger movements indicate the success of the procedure, though ongoing rehabilitation will be essential for full functional restoration. The case underscores the need for a rapid and coordinated response in cases of severe traumatic injuries, particularly when amputation is involved, and emphasises the critical role of microsurgical techniques in modern trauma care.
About Author –
Dr. Jammula S Srinivas, Consultant Plastic and Cosmetic Surgeon, Yashoda Hospital, Hyderabad
MS, Mch (Burns and Plastic Surgery)
