Transmetacarpal Replantation and Revascularization

중수골 부위 절단상(transmetacarpal amputation)에 시행한 재접합술

From march 1993 to march 1998, twenty consecutive transmetacarpal replantations and revascularizations were reviewed retrospectively. Nine patients sustained severe and diffuse crush injuries, four patients had local crush injuries, and seven suffered guillotine type amputation. Six replantations and fourteen revascularizations were performed. 76 of 81 replantable digits(93%) were salvaged. 15 patients required secondary surgery, 10 patients for tendon and joint scarring and 5 for nonunions or malunions. Intrinsic muscle function and pinch and grip strengths were weak or absent. According to Chen's grading system of functional return, 2(10%) were grade I, 6(30%) were grade II, 10(50%) were grade III, and 2(10%) grade IV. The follow-up period ranged from 6months to 46 months. Only 3 patients resumed his prior occupation(one as a supervisor); 2 were permanently disabled, 4 pursued new occupations as a manual worker, 1 were still in therapy. Only two of the manual laborers were able to return to their preinjury occupation. Despite these unacceptable functional results, all patients were satisfied with the surgery.