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KMID : 0358819830100030319
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Journal of Korean Society of Plastic and Reconstructive Surgeons
1983 Volume.10 No. 3 p.319 ~ p.325
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THE COMPLICATIONS OF REPLANTATION OF AMPUTATED FINGERS AND THEIR MANGEMENT
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Lee Sang-Ho
Wee Sung-Sin
Lim Poong
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Abstract
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Since the successful replantation of an amputated arm by Malt and McKhann in 1962, a large number of replantations have been performed on the world with survival rate of over 95 per cent, however, the functional recovery was not satisfactory. To obtain good functional recovery the complications following replantation must be prevented and managed adequately.
Authors reviewed the complications following replantations of 52 digits and a forearm which have been performed between March 1979 and March 1983 in the department of Plastic Surgery Catholic Medical School. The complications were 7 thrombosis, 3 profuse bledings, 4 nonunions, 1 malunion, 4 sensory disturbances, 27 limitation of motions and 2 partial skin necrosis.
Vascular complications were seen in 10 digits. Eight of them failed primarily because of thrombosis. Thrombosis of the anastomosis sites developed mostly within postoperative 24 hours. Re-exploration and thrombectomies were performed immediately but not improved due to long ischemic time or crushed type injury. Profuse bleeding occured in 3 digits on the postoperative 3rd to 4th day. In two of three cases the bleedings were controlled with cessation of heparinization and compressive dressing.
Nonunion and malunion of bone developed in 5 cases. Bone graftings were carried out in 4 cases to remedy the nonunion. Sensory recovery was relatively satisfactory in almost all patients but revisions and nerve grafting were needed in 4 patients.
Impaired joint motion was the most common problems in 27 digits ewpecially in PIP joint. Joint stiffness resulting from immobilization and adhesions in the extensor mechanism or within the flexor tendon sheath were the most common causes of the limited range of motion. In 4 disits tenolysis were performed and the results were satisfactory.
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