transmetacarpal amputations.

PATIENTS-METHODS: The last 14 years (1987-2001), 22 patients with complete mid-palm amputations were admitted in our department. All of them underwent replantation while other 5 patients were rejected on the grounds of age, degree of injury, time under ischemia, or other associated problems. Twenty-one patients were men and one patient was a young pregnant woman. The average age of the patients was 31 years. The type of the associated soft tissue trauma was graded at the time of admission as guillotine in 12 patients, crush in 6 patients and avulsion in 4 patients.

All patients were available for evaluation and the follow-up averaged 41 months after injury. The evaluation of hand function was based on the degree of sensibility on both sides of each finger, range of motion and flexion. Power grasp and lateral pinch were measured using a Jamar dynamometer.

RESULTS: Twenty patients were successfully replanted. All guillotine type amputations were successful. On the other hand ,1 crush type and 1 avulsion type injuries failed due to non-reflow phenomenon and infection respectively. The best functional outcome and return of digital sensibility occurred in a 28-year-old patient whose nerves were immediately repaired without tension. Intrinsic muscle function was absent or weak in all patients. Secondary reconstructive operations were performed in all successful cases including tenolysis, bone-grafting procedures, nerve grafting procedures and tendon transfers.

DISCUSSION: Replantation following transmetacarpal amputation led to successful rates of functional restoration and gave cosmetic appearance superior to any prosthesis. However, the return of hand intrinsic muscles was poor. The functional outcome of the replantation depends on the surgical skills, the type of injury and the age of patient.