Bilateral-hand amputation is extremely rare and double-hand replantation is even rarer. Only one case of successful double replantation at arm level has been reported from India. We present a case of double-hand replantation at proximal palmar level in a young adult executed in a small nursing home. The patient presented 5 h after injury with limbs preserved well in ice. There were difficulties in executing such an unusual case in a small nursing home set-up. The patient is performing his activities of daily living and basic functions independently. We share our experience of this double-hand replantation with special emphasis on problems encountered.
Giant cell tumor (GCT) at distal end of tibia is relatively a rare site of occurrence. We presented our experience with extensive excision and reconstruction for GCT of distal tibia using a free vascular double strut/single strut fibula graft. The present case series was conducted on six patients of GCT at lower end of tibia who were treated with extensive excision and reconstruction either in index (n=4) or recurrence (n=2) settings. Four patients were male and 2 were female. The mean age was 26.5 years. The average length of bone defect after tumor excision was 7.4 cm. The range of movement at ankle joint up to 70% of normal opposite side achieved in 2 cases and arthrodesis of ankle joint done in rest 4 cases (2 recurrent and 2 index cases). In GCT treatment, in spite of reconstruction difficulty for bony defect of lower end tibia due to its weight bearing property, vascularized free fibula graft has advantages like allows wide excision of tumor, single stage procedure, early weight bearing capacity in young patients and no bone resorption but bone thickening.
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