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Problems Associated with Forearm Reimplantation

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Jabłecki J., Kaczmarzyk J., Kaczmarzyk L., Domanasiewicz A., Kocięba R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
70-77
EN
The aim of the study was to present the technical and qualification problems associated with forearm reimplantation.Material and methods. The analysed group included 29 patients, 25 male and 4 female, who had in the period of 10 years (between January 1994 and December 2003) undergone 10 reimplantations and 19 revascularisations (partial amputation) of the forearm. The age of the patients ranged from 19 to 63 years. Due to massive limb destruction, 8 patients only underwent wound revision. The number of operations performed within the 4 distinct zones of the forearm was as follows: I - 8 patients, II - 17, III - 3, IV - 1; 20 (69%) of cases were the result of crush-avulsion injuries. The bones were stabilised by means of intramedullary nails, muscle bellies were sutured with mattress sutures, and the torn-off tendons were reinserted to the bellies by Chen's method. We attempted anastomosis of two main forearm arteries and the greatest possible number of veins, and a vein graft was applied in 2 cases. The operative wound was closed with skin graft in 4 patients.Results. There were 5 failures (17.2%). Nine patients required secondary reconstructive procedures for bone issues, 4 patients for nerves, and 3 for tendons. The operations were performed between 20 to 29 months after the reimplantation. The functional results were assessed according to Chen's scheme. 2 patients achieved grade I, 9 grade II, 13 grade III, and 5 grade IV. Two patients, the farmers, regained their previous profession. All of the patients were satisfied with regaining the limb.Conclusions. Problems encountered in forearm reimplantation are due to unfavorable mechanisms of trauma. The technical aspects of such surgeries require a highly qualified surgical team. The prognosis for survival and functional recovery is lower in proximal as compared to distal injuries.
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