[Hand replantation in an 88-year-old man: replanted senior?].
Indications of hand replantation need to take into account the patient overall condition and assess the magnitude of the injury. Although elderly people are usually considered as a limiting factor for microsurgery, indications of replantation may sometimes be extended. The author reports the case of a complete right hand amputation by a circular saw in an active right-handed 88 year man. The trans-carpal section was clean and general condition of the patient was satisfying. It was decided with the patient consent and the anaesthetist and the surgeon to perform the replantation. The procedure was carried on during 6 hours and revascularization took place 5 h 1/2 after injury. Post-operative period has been easy, but superficial nosocomial wound infection appeared which recovered with antibiotic therapy. It was not necessary to reoperate and the patient did not stay in intensive care department. After almost a 2 years follow-up, peripheral pulses were present, and the hand was warm and well coloured. Poor sensibility was found in median nerve area. Intrinsic motion was missing and extrinsic range of motion was weak. From a functional point of view, the patient was able to write, to dig his garden, and to drive his car. Analysis of this supposed hand replanted senior case report demonstrates that, when general and local conditions are safe, a hand replantation, even with a poor result, may be better than a prosthesis or an allograft, whatever the age of the patient.
Liverneaux
P
P
Service de chirurgie orthopédique et traumatologique, centre hospitalier, BP 9, 17301 Rochefort-sur-Mer, France. p.liverneaux@tiscali.fr
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000673:Amputation, Traumatic / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D009048:Motor Skills; D018908:Muscle Weakness; D011788:Quality of Life; D012092:Replantation; D016896:Treatment Outcome