title: Hand Amputations at the Radiocarpal Level With Proximal Neuromuscular Avulsion.
abstract: OBJECTIVE
  To report a series of 6 radiocarpal avulsion amputations in 5 patients.
  
  
  METHODS
  We replanted 6 radiocarpal amputations in 5 patients with proximal musculotendinous and nerve avulsion between 2005 and 2013 and reviewed them retrospectively. All 5 patients were men, age range from 21 to 32 years. Functional results were evaluated through total active motion (TAM) of the fingers, 2-point discrimination, monofilament test, grip strength, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Follow-up was 4 to 10 years.
  
  
  RESULTS
  All replanted parts survived without systemic complications. No infections or major wound complications occurred despite the preservation of presumably avascular tendons. The functional results of the right side in patient 1 who suffered bilateral amputations, were very modest, with only 360° of TAM (about 30% of the TAM of a normal hand) and weak grip after 5 secondary surgical procedures including 2 free functional gracilis transfers. This was the only hand in which the tendons were not reinserted primarily. The other hands achieved TAM between 590 and 820°, which corresponds roughly to 50% to 70% of the normal TAM of a healthy hand, and mean of 10-kg grip force.
  
  
  CONCLUSIONS
  Radiocarpal amputation with proximal musculotendinous avulsion is an infrequent pattern of injury in which replantation with tendon reinsertion can yield functional results comparable with those reported for sharp wrist-level amputations.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain.
authors.forename: Pedro C
authors.initials: PC
authors.lastname: Cavadas
authors.affiliation: Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain. Electronic address: althione@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Thione
authors.affiliation: Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rubí
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D004185:Disability Evaluation; D006230:Hand Injuries / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D011826:Radial Nerve / Q000293:injuries / Q000601:surgery*; D012092:Replantation; D012189:Retrospective Studies; D013709:Tendon Transfer; D014459:Ulnar Nerve / Q000293:injuries / Q000601:surgery*; D055815:Young Adult
keywords: Hand; amputation; avulsion; microsurgery; tendon