Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Abstract

Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management.

Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases.

Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation.

Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

Keywords

hand - wrist - replant - amputation - hand therapy - early motion protocol

Publication History

Article published online:
02 November 2019

• References

• 1 Chesney A, Chauhan A, Kattan A, Farrokhyar F, Thoma A. Systematic review of flexor tendon rehabilitation protocols in zone II of the hand. Plast Reconstr Surg 2011; 127 (04) 1583-1592
• 2 Farzad M, Layeghi F, Asgari A, Ring DC, Karimlou M, Hosseini SA. A prospective randomized controlled trial of controlled passive mobilization vs. place and active hold exercises after zone 2 flexor tendon repair. Hand Surg 2014; 19 (01) 53-59
• 3 Kannas S, Jeardeau TA, Bishop AT. Rehabilitation following zone II flexor tendon repairs. Tech Hand Up Extrem Surg 2015; 19 (01) 2-10
• 4 Ng WK, Kaur MN, Thoma A. Long-term outcomes of major upper extremity replantations. Plast Surg (Oakv) 2014; 22 (01) 9-13
• 5 Salminger S, Sturma A, Roche AD. et al. Functional and psychosocial outcomes of hand transplantation compared with prosthetic fitting in below-elbow amputees: a multicenter cohort study. PLoS One 2016; 11 (09) e0162507
• 6 Gulgonen A, Ozer K. Long-term results of major upper extremity replantations. J Hand Surg Eur Vol 2012; 37 (03) 225-232
• 7 Maricevich M, Carlsen B, Mardini S, Moran S. Upper extremity and digital replantation. Hand (N Y) 2011; 6 (04) 356-363
• 8 Bueno E, Benjamin MJ, Sisk G. et al. Rehabilitation following hand transplantation. Hand (N Y) 2014; 9 (01) 9-15
• 9 Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res 2015; 473 (05) 1747-1754
• 10 Patel AA, Blount AL, Owens PW, Askari M. Functional outcomes of replantation following radiocarpal amputation. J Hand Surg Am 2015; 40 (02) 266-270
• 11 Cavadas PC, Thione A, Rubí C. Hand amputations at the radiocarpal level with proximal neuromuscular avulsion. J Hand Surg Am 2016; 41 (01) 70-75