Midcarpal Amputation Of The Hand

SavageGlow · #1 ● 07-25-2024, 08:45 PM

Case Report:

A 30-year-old cheesemaker presented in the emergency room with a severe mutilating avulsion injury of the hand and forearm. His right adominant hand was pulled in a cheese cutting machine with six circular saw blades working in opposition to each other. He sustained a midcarpal amputation of the hand, a complete avulsion of the long fingers, a splitting of the forearm with extended palmar soft tissue flap, dorsal extensive soft tissue defect with laceration of the extensor muscles and an open ulnar shaft fracture, defined as third grade (IIIB) according to the classification of Gustilo and Anderson (Figure 1).

In order to cover the large soft tissue defect, while in addition simultaneously reconnecting a palmar artery of the thumb to the radial artery and a dorsal vein to one in the forearm, an anterolateral thigh (ALT) flap was used as an emergency free flow-through flap (Figure 2).

Follow-up:
The thumb had an astonishing good function after the therapy. One year after the operation, he was able to return to work in a bigger factory and a more modern workplace with highly automated machinery (Figure 5).