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Upper limb replantations 10 year analysis (1992–2001)
THE IOURNAL
74
OF HAND
SURGERY
VOL. 288 SUPPLEMENT
I
SESSION 17: REPLANTATION AND TISSUE TRANSFER 140. UPPER LIMB REPLANTATIONS 10 YEAR ANALYSIS (1992-2001)
Pedro Natividade da Silva, M. Marques, E. Malheiro, J. Reis, J. Amarante. Institution/Hospital: Service de Cirurgiu Pla’sticn, Hospitul de $50 Jotio, Alum. Hernuni Monteiro, 4200 Oporto, Portugal
The use of microvascular techniques in the Plastic and Reconstructive Surgery Department began in 1980. The Hospital de .%o Jolo, located at Oporto, is the only hospital in the northern region of Portugal which has in the Emergency Service, specialists of Plastic and Reconstructive Surgery available 24 hours per day, 7 days per week. The majority of the patients following amputation with a possible indication for replantation are therefore sent there. This work presents replantations of the upper limb during the decade 1992-2001, and is illustrated by clinical cases.
141. SINGLE FINGER ECTOPIC TRANSPLANTATION, REPORT OF FIFTEEN CASES Shahram Nazerani. Iran Medical Universit): Apt. 3, No. 7 Mesri St., Yunnohumadi Ave. Darus, Shariati, 1944 Teheran, lrun Single finger replantation has gained acceptance although reluctantly by hand surgeons the results have supported the concept. Ectopic single finger transplantation has been performed by Chernofsky and Hallock but the long term results have not been reported. A six year experience of single finger transplantation is reported and although the technic is rather demanding the results are far superior than a prosthesis or other means of finger reconstruction.
142. FUNCTIONAL RESULTS OF THE ITALIAN HAND TRANSPLANTATION PROGRAM
to variations of the immunological status of the patients. Transient side effects have been minimal so far and currently the patients are free from any complication. Both patients are highly satisfied with the procedure and returned to their previous occupations.
143. THE TRAP AT THE VENOUS DRAINAGE OF FREE TISSUE TRANSFERS: THE IMPORTANCE OF THE RECIPIENT VEIN CHOICE Fadh Parmaksizoglu, Tahsin Beyzadeoglu. Yeditepe Universig, Faculty of Medicine, Dept. Istunbul, Turkey
of Orthopuedicsand
Truumatology,
Symptoms including bluish-to-purple discoloration, oozing from the edges and the undersurface of the Rap. engorgement and edema can be observed after free tissue transfers as a possible outcome of venous failure/occlusion or ischaemia-reperfusion injury. The status of the whole length of the recipient vein is not taken into consideration during the performance of venous anastomosis. While the patency and flow quality of the recipient artery can easily be detected by the pulsatile flow at its distal end, it is obviously not possible to evaluate the patency of the recipient vein, proximal to the anastomosis level. In a number of microsurgical operations including free flap transfers. we observed venous failure although the inspection of the venous anastomosis site did not reveal any problem. Exploration of the recipient vein proximal to the anastomosis site revealed signs of anatomical derangements such as occlusion at a bifurcation, constriction by fibrous tissue or severe collapse. Based on the experience from these cases, we decided to test the patency and drainage capacity of the recipient vein prior to anastomosis. We measure the intravenous pressure via an intmluminal catheter connected to a saline bag. We proceed with venous anastomosis if the measurement is within normal limits. We suggest this technique as a simple precaution to unexplained venous failure problems in microsurgical flap transfers.
M. Lanzetta. Hand Surgery and Reconstructive Microsurgery Unit, Universig
of Milan-Bicocca,
Italy
Two transplanted patients were evaluated at 24 months and 13 months to assess sensory and motor recovery, brain remodelling and dexterity. Protective sensation was achieved in all digits and initial evidence of discriminative sensation was present in both patients. Reinnervation of the intrinsic muscles was detected using a surface multichannel electromyographic system able to evaluate the contribution of single motor units in each muscle. Brain remodelling and cortical shifting to a pre-amputation typical patterns was faster in the patient using a sensory glove in the immediate postoperative period. Great detail was given to evaluate the psychological impact of the operation, with emphasis on the family, social and work implications due to the variations in body image and anatomical integrity. Antirejection therapy was maintained at minirndl levels, and rejection episodes were sporadic, fully reversible and occurred only in the first 3 months. Monitoring skin rejection was better achieved by means of a “island skin graft sentinel” sensitive
14. EMERGENCY FREE FLAPS IN SOLVING COMPLEX TRAUMA OF THE UPPER LIMB Al. V. Georgescu, Ivan Ovidiu. Plastic Surgery Clinic, Cluj Nupoctr, Romania
The results following severe destructive trauma of the hand are strongly influenced by adopting the correct emergency strategy and management. For cases involving large soft tissue defects and exposure of the vital structures our strategy involves the use of immediate free tissue transfer to obtain primary healing and a good functional result. We present our strategy and our proposal for a new classification including the concept of immediate emergency free Raps (in the first 12 hours). Materials and methods: In the last 7 years we used this approach in 44 cases of which 21 were immediate free flaps. Etiology of fever limb trauma treated with an emergency free flap included crush injuries (14 cases), partial or complete amputation (20 cases)
74
OF HAND
SURGERY
VOL. 288 SUPPLEMENT
I
SESSION 17: REPLANTATION AND TISSUE TRANSFER 140. UPPER LIMB REPLANTATIONS 10 YEAR ANALYSIS (1992-2001)
Pedro Natividade da Silva, M. Marques, E. Malheiro, J. Reis, J. Amarante. Institution/Hospital: Service de Cirurgiu Pla’sticn, Hospitul de $50 Jotio, Alum. Hernuni Monteiro, 4200 Oporto, Portugal
The use of microvascular techniques in the Plastic and Reconstructive Surgery Department began in 1980. The Hospital de .%o Jolo, located at Oporto, is the only hospital in the northern region of Portugal which has in the Emergency Service, specialists of Plastic and Reconstructive Surgery available 24 hours per day, 7 days per week. The majority of the patients following amputation with a possible indication for replantation are therefore sent there. This work presents replantations of the upper limb during the decade 1992-2001, and is illustrated by clinical cases.
141. SINGLE FINGER ECTOPIC TRANSPLANTATION, REPORT OF FIFTEEN CASES Shahram Nazerani. Iran Medical Universit): Apt. 3, No. 7 Mesri St., Yunnohumadi Ave. Darus, Shariati, 1944 Teheran, lrun Single finger replantation has gained acceptance although reluctantly by hand surgeons the results have supported the concept. Ectopic single finger transplantation has been performed by Chernofsky and Hallock but the long term results have not been reported. A six year experience of single finger transplantation is reported and although the technic is rather demanding the results are far superior than a prosthesis or other means of finger reconstruction.
142. FUNCTIONAL RESULTS OF THE ITALIAN HAND TRANSPLANTATION PROGRAM
to variations of the immunological status of the patients. Transient side effects have been minimal so far and currently the patients are free from any complication. Both patients are highly satisfied with the procedure and returned to their previous occupations.
143. THE TRAP AT THE VENOUS DRAINAGE OF FREE TISSUE TRANSFERS: THE IMPORTANCE OF THE RECIPIENT VEIN CHOICE Fadh Parmaksizoglu, Tahsin Beyzadeoglu. Yeditepe Universig, Faculty of Medicine, Dept. Istunbul, Turkey
of Orthopuedicsand
Truumatology,
Symptoms including bluish-to-purple discoloration, oozing from the edges and the undersurface of the Rap. engorgement and edema can be observed after free tissue transfers as a possible outcome of venous failure/occlusion or ischaemia-reperfusion injury. The status of the whole length of the recipient vein is not taken into consideration during the performance of venous anastomosis. While the patency and flow quality of the recipient artery can easily be detected by the pulsatile flow at its distal end, it is obviously not possible to evaluate the patency of the recipient vein, proximal to the anastomosis level. In a number of microsurgical operations including free flap transfers. we observed venous failure although the inspection of the venous anastomosis site did not reveal any problem. Exploration of the recipient vein proximal to the anastomosis site revealed signs of anatomical derangements such as occlusion at a bifurcation, constriction by fibrous tissue or severe collapse. Based on the experience from these cases, we decided to test the patency and drainage capacity of the recipient vein prior to anastomosis. We measure the intravenous pressure via an intmluminal catheter connected to a saline bag. We proceed with venous anastomosis if the measurement is within normal limits. We suggest this technique as a simple precaution to unexplained venous failure problems in microsurgical flap transfers.
M. Lanzetta. Hand Surgery and Reconstructive Microsurgery Unit, Universig
of Milan-Bicocca,
Italy
Two transplanted patients were evaluated at 24 months and 13 months to assess sensory and motor recovery, brain remodelling and dexterity. Protective sensation was achieved in all digits and initial evidence of discriminative sensation was present in both patients. Reinnervation of the intrinsic muscles was detected using a surface multichannel electromyographic system able to evaluate the contribution of single motor units in each muscle. Brain remodelling and cortical shifting to a pre-amputation typical patterns was faster in the patient using a sensory glove in the immediate postoperative period. Great detail was given to evaluate the psychological impact of the operation, with emphasis on the family, social and work implications due to the variations in body image and anatomical integrity. Antirejection therapy was maintained at minirndl levels, and rejection episodes were sporadic, fully reversible and occurred only in the first 3 months. Monitoring skin rejection was better achieved by means of a “island skin graft sentinel” sensitive
14. EMERGENCY FREE FLAPS IN SOLVING COMPLEX TRAUMA OF THE UPPER LIMB Al. V. Georgescu, Ivan Ovidiu. Plastic Surgery Clinic, Cluj Nupoctr, Romania
The results following severe destructive trauma of the hand are strongly influenced by adopting the correct emergency strategy and management. For cases involving large soft tissue defects and exposure of the vital structures our strategy involves the use of immediate free tissue transfer to obtain primary healing and a good functional result. We present our strategy and our proposal for a new classification including the concept of immediate emergency free Raps (in the first 12 hours). Materials and methods: In the last 7 years we used this approach in 44 cases of which 21 were immediate free flaps. Etiology of fever limb trauma treated with an emergency free flap included crush injuries (14 cases), partial or complete amputation (20 cases)