Echieh Chidiebere Peter, Ozinko Mba, Omoregbee Benjamin Irene, Okonta Kelechi Emmanuel
Department of Surgery, University of Calabar, Calabar, Cross River, Nigeria
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria.
BMJ Case Rep. 2021 Mar 2;14(3):e238393. doi: 10.1136/bcr-2020-238393.
Amputations of the upper limb, in particular, have a major impact on patients' lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.
尤其是上肢截肢对患者的生活有重大影响，因为功能丧失不仅会导致日常生活中的自主性降低，还会妨碍社交互动和工作能力。在腕部或其近端进行再植，即腕部近端再植，仍然是一项艰巨的挑战，给手外科医生带来了一系列与断指再植不同的困难。我们介绍了在撒哈拉以南非洲地区为一名25岁男性成功进行非优势左手腕近乎完全离断再植的经验。再植两年后，患者的上肢、肩部和手部功能障碍评分为40分，两点辨别觉为6毫米。我们还讨论了限制热带地区再植发展的特殊挑战。环境温度、人力、专业知识和技术可能是限制热带地区这种手术开展的因素。
