 This
patient suffered a devastating avulsion
amputation injury of his right
hand. Tendon avulsion was present
on the extensor aspect, but the median
nerve and flexor tendons were cut
sharply.
 Because
of the avulsive nature of the injury the
forearm and hand required fasciotomy to
prevent compartment syndrome.
 Radiographs
revealed the amputation to be through
the mid carpal level. The proximal
row was left attached to the forearm.
 The
hand did have some component of crush
injury but there were no significant
fractures present other than the
amputation site.
 The
hand was replanted via the radial artery
and cephalic vein. An implantable
Doppler probe was used to monitor
post-operative blood flow in the
replanted hand. The volar forearm
wound had to be left open as a result of
the massive edema that followed.
 Axially
placed k-wires were used to hold the
bone in reduction. The Amputation
level was through the mid-carpus.
A proximal row carpectomy was performed
for shortening.
Post-operative
function is shown about two years after
injury. The patient required
radial nerve type tendon transfers to
power wrist and finger extension.
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