gms | German Medical Science

Objectives/Interrogation: The experience and ability to solve highly complex pathologies in reconstructive traumatology, integrate the management of complex wounds with multisystemic commitment and microsurgery. Secondary to complex traumatic subtotal hand amputation.

Methods: Male patient, 34 years old. Enter by subtotal amputation with circular saw. Start of cut dorsal area in the right distal ulnar region. Exposed radio-ulnar fracture (GIIIC), extensor apparatus damage in zone 8, radial nerve injury and partial radial artery section. Damage control. In pavilion, wound washing, identification of structures, control of bleeding with partial repair of radial artery, superficial closure and placement of external tutor. 48 hours later, withdrawal of external tutors, new wound washing. Reduction and radio-ulnar osteosynthesis is performed, after regularization of bone ends, with LCP plates. Identification of nervous, tendon and vascular tissue sectioned. Revision and new repair of the radial artery is performed, revision of flow without active bleeding. Epineurorrhaphy of radial nerve in zone 8 posterior regularization of ends, primary with suture without tension. Functional identification of extensor tendons, distal and proximal ends are identified. Primary tenorrhaphy of extensor tendons in all the compartments of 1st to 5th fingers at the level of the retinaculum with double point kessler plus point running between ends. Complete mobility check of the wrist is made with correct nerve tension and tendon, it is expected to achieve early controlled mobility. Operative wound closure. Placing of ante-brachial palmar plaster valve including phalanges.

Results and Conclusions: Repair of complex wounds with multisystemic compromise is a big challenge, secondary to that, traumatic injury in February 2018, with circular saw. Complete repair 48 hours after first intervention with damage control. 2 weeks after performing surgery, removal of sutures, passive mobility test, sensitivity and pain scale. On the part of our rehabilitator, evaluation with DASH 70.8%. Great pain secondary to surgery. Follow-up was performed for 7 months. Achieving pain reduction, without complications such as complex regional pain, almost complete sensitivity, complete passive and active mobility and DASH (7 months) 18.3 with complete work reintegration. Good planning and achieving what is theoretically demonstrated (neurorrhaphy, tenorrhaphy), it is essential for a good result of the management of these complex wounds, it makes life easier for the surgeon and the patient is grateful.