Forequarter Replantation and the Lessons Learnt

Abstract

Summary:The literature on major upper limb replantation, especially those proximal to the elbow, is inadequate. An 18-year-old man presented to us with a left forequarter amputation. A replantation was attempted with a view to salvaging function and avoiding prosthesis. The procedure was technically challenging with a number of issues not highlighted in previous reports, particularly bony stabilization. The procedure was initially successful, with good perfusion. However, with time, the limb showed sepsis and had to be abandoned. We report this case to add to the literature on replantation at the shoulder level in the hope that this procedure may be reported successfully in the future.

Replantation in scapulothoracic avulsion amputation of the right upper limb in a 3-year-old child- A preliminary report

“…Although Venkatarama et al in 2015 have reported a case of scapulothoracic avulsion amputation in a 18-year-old male, the replanted limb had to be amputated due to ensuing sepsis. [3] Hence, to our knowledge, this is the first reported case of a successful replantation of a limb separated at scapulothoracic level.…”

Replantation of forequarter amputation: Report of two cases with successful structural, motor and sensorial results

“…As highlighted in the limited number of previous reports, one of the major challenges in forequarter amputation (scapulothoracic disarticulation) is stabilization of the limb to its original location on the chest wall. In previous reports, authors have used plates to stabilize the acromioclavicular joint or else multiple K‐wires to fix the limb to the chest (Mahendru et al, 2016; Venkataram et al, 2015; Witz et al, 2000; Zelle et al, 2004). However, it should be remembered that traction will lead to avulsion, and thus to amputation from the weakest part.…”

“…However, those authors also reported that the extent of neural recovery is questionable, since the most recent follow-up at 18 months postoperatively revealed only evidence of recovery of crude-touch sensations (protective sensation) up to the digits without noting any motor recovery. Venkataram et al reported a case of replantation of a forequarter amputation in an 18-year-old man which required re-amputation due to life-threatening sepsis 14 days postoperatively (Venkataram et al, 2015).…”