By Professor R. A. Dickson MA, ChM, FRCS, DSc (Editor)
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Additional resources for Current Orthopaedics. Volume 22 (2008) (continued 2009 as Orthopaedics and Trauma)
The best results are at the wrist and distal forearm level. This correlates to Chuang Figure 4 (a, b) The appearance and radiographic ﬁndings of a patient after amputation of all digits except the thumb. Note the different levels of injury in each digit. (c) The ﬁxation of the bone with plates and screws illustrates the principle of transpositional digital replantation, with the more competent amputates placed on the most competent stumps. (d, e) The appearance of the hand prior to discharge showing good range of movement of the ﬁngers and valuable hand function.
3. The amputated part has segmental injuries or is severely mangled (Fig. 3). 4. There is a prolonged ischaemia time and concern regarding reperfusion injury and systemic injury. 5. The amputated part cannot be located or there is confusion about whether the part belongs to the patient, for instance in the rare situation where there are multiple victims with amputations. ARTICLE IN PRESS Mini-symposium: Hand trauma 35 Figure 3 (a, b) An example of an upper limb amputation that was not suitable for replantation.
Treat with standard bone and soft tissue techniques 2a Inadequate arterial supply, without skeletal injury. Suitable for vascular repair alone 2b Inadequate venous supply, without skeletal injury. Suitable for vascular repair alone 3 Inadequate circulation with associated skeletal injury. Suitable for vascular repair following bone or joint repair. Because the part is not completely amputated the option of skeletal shortening is restricted 4 Complete injuries. Suitable for replantation with the advantage that the skeleton may easily be shortened, often avoiding the need for vascular or nerve grafts.