ABSTRACT
A case is presented of a 23-year-old male who sustained a traumatic transmetacarpal
amputation of his nondominant hand. The injury consisted of complete severance of
structures distal to the midpalm. Microsurgical reconstruction involved the primary
repair of arteries, veins, nerves, extensor and flexor tendons, and metacarpal fractures.
Skeletal reconstruction also employed a primary Swanson prosthesis for the fifth metacarpophalangeal
(MP) joint. Early postoperative range-of-motion exercises were encouraged, with the
achievement of a functionally capable replanted extremity. The general management
of an amputation injury is also discussed, as it applies to a community hospital environment.
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Editorial Note. This case report is being published to emphasize the growing number of surgeons becoming
expert in microvascular techniques. The institution of a replantation team either
in a university or community hospital requires more than technical competence. It
requires the commitment of a number of dedicated surgeons to accept transfers requiring
replantation surgery on a continual basis. Amputation injuries urgently require prompt
care. Referring physicians must be able to expect rapid transfer to a replantation
center at all times. Prompt attention by this community-based replantation team resulted
in this admirable case report. B.S.
