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Total Hand Replantation Outcome with Early Motion Protocol
Lucas M. Harrison BS, Spencer R. Anderson MD, Sunishka M. Wimalawansa MD MBA.
Dept. of Orthopedic and Plastic Surgery, Wright State University
2018-01-30
Presenter: Spencer R. Anderson
Affidavit:
Spencer R. Anderson, MD
Director Name: R. Michael Johnson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
PURPOSE: This study highlights a replantation case of a 57-year-old with traumatic complete right hand amputation with emphasis on immediate postoperative implementation of an early motion protocol
METHODS: Retrospective chart review was performed, assessing number of rehab visits, final range of motion, and return to work and/or daily activities as the outcome measures.
RESULTS: Replantation of the right hand in zone 4 was performed including fixation of 5 metacarpal fractures and reconstruction of thumb metacarpal CMC fracture-dislocation; the reduction was supported by rigid external fixation spanning the forearm and hand. Microsurgical repairs were performed on all arteries and nerves. An early active motion "place-and-hold" protocol was initiated within the first week. MPJ motion was tethered by the pins, limiting full excursion; resulting in stiffness and extensor adhesions that required a staged extensor tenolysis, however the joints remained supple. The motion protocol prevented need for significant flexor tenolysis. He also required opponensplasty. Final results include nearly full active ROM, good intrinsic function, independent finger motion, and 65 lb functional grip strength.
CONCLUSION: Early motion rehab protocols can significantly improve results in complex replantation. Our case highlighted this, particularly regarding the degree of extensor adhesions caused by even minor extensor tethering, which we plan to minimize in future cases.
This approach can help produce excellent range of motion, superior to other less aggressive postoperative plans.
