Hand Replantation By Microsurgical Technique:

Walla.ikram El-assiouty

Replantation of the amputated hand couldn’t be possiblewithout the introduction of microsurgical techniques whichenable the specialized surgeons to succssfully anastomose smallvessels even those less than 2 mm in diameter.Therefore a good knowledge of the anatomy of thesevessels and nerves supplying the hand is essential for the microvascular surgeon, especially during preparation of the amputated part and the stump in order to identify the vessels and nerves to be anastomosed.For dissection and anastomoses of those small vessels the microvascular surgeon has to be familiar with the microsurgical instrumentation, and he should have a good experience in dealing with those fine instruments in a microsurgical lab before playing a role in a microvascular surgery.Transportation of the patient and amputated part should be done carefully by using special methods.When the patient arrives at the microsurgical center he should have a complete physical examination together with the routine different investigations. After an initial assessment of the patients injuries, other factors influencing the outcome ofreplantation are evaluated in the development of a rational decision about replantation.The replantation candidate is then transferred to the microsurgical operating theater where repair is done in the following order :1-Bone shortening and fixation.2-Repair of extensor tendons.3-Repair of flexor tendons.4-Repair of arteries.5-Repair of nerves.6-Repair of veins.7-Closure and coverage of the wound.After completing the surgical procedures a strict post operative management together with close observation and monitoring of the microcutaneous circulation are critically essential for the success of the procedure, followed by an effective rehabilitation program to assume a good functional results.Finally, after the tremendous success in replanting the amputated parts in many microsurgical centers, still the majority of the public arc unaware of how to keep and transport the amputated parts, and even most of them don’t have any idea about the possibility of replanting the amputated parts.That is why it may be necessary for the microsurgicalcenters to throw the lights on the success of the replantation procedure through the different media, and to give the public a good knowedge about how to care with the amputated part and preserve it till they reach the microvascular center.