Major replantation A report of three cases

Three cases, of major traumatic amputations were treated during the period 1988 - 1991 by replantation. One case failed and two were successful. Case 1: Age 10 years. He had right below elbow and left below knee traumatic amputations, sustained in a subway accident. Operative ischaemic time 10 hours. Because of general toxaemia and established gangrene a below knee amputation was performed on the third day, and a below elbow amputation on the ninth day. Case 2 Age 28 years. Sharp traumatic amputation of left distal forearm inflicted by an electric saw. Surgery: Two hours delay, but amputated segment in ice. D‚bridement, bone shortening, Steinmann pin internal fixation, anastomosis of cut radial and nlnar arteries and of four dorsal veins, Suture of median and ulnar nerves and of flexor and extensor tendons. Split thickness skin graft. U-plaster slab. Operative ischaemia time: 9.5 hours. After operation: Heparin, antibiotics, analgesics, dextran. After 5 months: external fixation. After 3 months: internal fixation and revision of tendon lengths. After 3 years: Chen et al Grade II functional result. Case 3 : 14 years old. Left midforearm avulsion amputation with degloving after being caught in the engine of a water pump. Surgery: Bone shortening, internal Rush pin fixation; anastomotic repair of radial artery, one vena comitante, basilic and cephalic veins; median nerve suture. Ulnar and radial nerves found avulsed; coaptation of motor branch of distal ulnar nerve to radial nerve; flexor muscle mass reattached to flexor pollicis longus tendon; pronator teres used to motorise fingers. Total of 5.5 hours of cold ischaemia; 9 hours operative ischaemia. Postoperativeiy: decongestive therapy, After 2 months: 8cm sural nerve graft between radial nerve and extensor muscles. Final Chen et al Grade III. It is explained that in Egypt difficulties met with are high cost of operation room time hiring, of necessary medication, and lack of insurance coverage