Microsurgical replantation of right forearm after accidental amputation at work

22 agosto, 2016

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The patient, male, 28, suffers the traumatic amputation of part of his right arm in an accident at work. An industrial plastic cutting machine severs his upper limb above the forearm.

He is transferred in helicopter from the site of the accident (Vizcaya) to Clínica Mompía, what allows going into the operating room less than five hours after amputation; a factor that will be key in the final result of the medical approach to the case.

The problem

After an amputation with these characteristics, time runs against the patient’s expectations of recovery. Muscle tissue is no longer reinjertable due to its extreme toxicity after around six hours without blood flow, given its dependence on oxygen and the process of cell death or necrosis unfastened by the lack of it.

The objectives

The main goal of the surgical unit of Dr. Del Piñal in this and other cases of similar profile is to achieve a successful replantation using microsurgery, assessable according to the degree of functional and aesthetic recovery of the patient in the medium term.

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In the above combination of images, the aesthetic and functional recovery of the patient is shown. To the left the postoperative situation can be seen in detail, while, in the right picture, the functional capacity and the aspect of the limb after nine months illustrate the success of the procedure.

The plan 

Del Piñal and his team, with a success rate in microsurgical interventions at around 99%, design a procedure in several phases. First, situation of the tissues is stabilized, based on the development of a complex system of blood flow through artificial plastic arteries. Then, once the flow and vitality are restored, the replantation itself begins.

As an initial step, the surgical unit works on the muscle, then comes the bone structure and, subsequently, the reinsertion of tendons, nerves and veins is articulated. Finally, the arterial reconstruction closes a process of about four hours of microsurgery.

The results

Just several hours after the operation the patient regains color and sensitivity in the fingers of the affected limb. After three weeks, the rehabilitation therapy starts. At nine months, the arm has good mobility and capacity to exert force, with a cuasinormal performance for daily life tasks.