Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 3 ( September-December, 2021 ) > List of Articles


Distal Forearm Replantation in a Child: A Case Report with a 30-year Follow-up

Lee S Hee, Kim Hyung-Sik, Hong-Chul Lim

Keywords : Case report, Distal forearm replantation, Replantation in children, Upper limb replantation

Citation Information : Hee LS, Hyung-Sik K, Lim H. Distal Forearm Replantation in a Child: A Case Report with a 30-year Follow-up. 2021; 16 (3):179-183.

DOI: 10.5005/jp-journals-10080-1532

License: CC BY-NC-SA 4.0

Published Online: 15-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Amputation in the upper extremities influenced the quality of life a lot adversely. So, replantation was tried in many cases of amputation. Especially, due to good plasticity and healing capacity, replantation in children should be actively attempted. On the contrary, owing to growth potential in children, there are several late complications to happen like shortening and synostosis. There are only a few long-term follow-up reports of paediatric patients after replantation of upper extremities. We report a case of successful distal forearm replantation in a 2-year-old child who sustained a wringer injury by a sawing machine with a follow-up of 30 years. Case description: A 2-year-old female patient was brought to our institution after a wringer injury to the distal forearm by a sawing machine. She sustained a near-total amputation at the distal forearm level with only a skin tag. Replantation was performed 4 hours after the injury. Radius and ulnar fractures were fixed with Kirschner and roll wires. The radial and ulnar arteries were anastomosed and three veins were anastomosed too. The median, ulnar, and radial nerves were managed by epi-perineurorrhaphy. The muscles were readapted, flexor tendons were performed tenorrhaphy each by each, and extensor tendons were performed grouping tenorrhaphy. Ten years after the replantation, a supination motion block was developed but successfully managed. Conclusion: Replantation of upper limbs in children is an eceedingly worthwhile procedure. Though due to growth potential several complications were developed unlikely in adults. But those can be improved with additional procedures. Good plasticity and healing capacity of children make good functional outcomes in long-term follow-up. So, replantation of upper limbs in children should essentially be considered and aggressively performed.

  1. Larson JV, Kung TA, Cederna PS, et al. Clinical factors associated with replantation after traumatic major upper extremity amputation. Plast Reconstr Surg 2013;132(4):911–919. DOI: 10.1097/PRS.0b013e31829f4a49.
  2. Mattiassich G, Rittenschober F, Dorninger L, et al. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskelet Disord 2017;18(1):77. DOI: 10.1186/s12891-017-1442-3.
  3. Wolfe VM, Wang AA. Replantation of the upper extremity: current concepts. J Am Acad Orthop Surg 2015;23(6):373–381. DOI: 10.5435/JAAOS-D-14-00039.
  4. Chang J, Jones N. Twelve simple maneuvers to optimize digital replantation and revascularization. Tech Hand Up Extrem Surg 2004;8(3):161–166. DOI: 10.1097/01.bth.0000134711.75677.3b.
  5. Pederson WC. Replantation. Plast Reconstr Surg 2001;107(3):823–841. DOI: 10.1097/00006534-200103000-00027.
  6. Soucacos PN. Indications and selection for digital amputation and replantation. J Hand Surg Br 2001;26(6):572–581. DOI: 10.1054/jhsb.2001.0595.
  7. Kim JY, Brown RJ, Jones NF. Pediatric upper extremity replantation. Clin Plast Surg 2005;32(1):1–10, vii. DOI: 10.1016/j.cps.2004.09.003.
  8. Iorio ML. Hand, wrist, forearm, and arm replantation. Hand Clin 2019;35(2):143–154. DOI: 10.1016/j.hcl.2018.12.005.
  9. Kane PM, Vopat BG, Got C, et al. The effect of supination and pronation on wrist range of motion. J Wrist Surg 2014;3(3):187–191. DOI: 10.1055/s-0034-1384749.
  10. Beris AE, Soucacos PN, Malizos KN, et al. Major limb replantation in children. Microsurgery 1994;15(7):474–478. DOI: 10.1002/micr.1920150708.
  11. Waikakul S, Vanadurongwan V, Unnanuntana A. Prognostic factors for major limb re-implantation at both immediate and long-term follow-up. J Bone Joint Surg Br 1998;80(6):1024–1030. DOI: 10.1302/0301-620x.80b6.8761.
  12. Baker GL, Kleinert JM. Digit replantation in infants and young children: determinants of survival. Plast Reconstr Surg 1994;94(1):139–145. DOI: 10.1097/00006534-199407000-00015.
  13. Saies AD, Urbaniak JR, Nunley JA, et al. Results after replantation and revascularization in the upper extremity in children. J Bone Joint Surg Am 1994;76(12):1766–1776. DOI: 10.2106/00004623-199412000-00003.
  14. Sugun TS, Ozaksar K, Ada S, et al. Long-term results of major upper extremity replantations. Acta Orthop Traumatol Turc 2009;43(3):206–213. DOI: 10.3944/AOTT.2009.206.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.